Provider Demographics
NPI:1679720130
Name:DIEP, XUAN (DC)
Entity type:Individual
Prefix:DR
First Name:XUAN
Middle Name:
Last Name:DIEP
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:913 WHITE KNOLL DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90012-1312
Mailing Address - Country:US
Mailing Address - Phone:213-482-4772
Mailing Address - Fax:
Practice Address - Street 1:913 WHITE KNOLL DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-1312
Practice Address - Country:US
Practice Address - Phone:213-482-4772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC 28057111NS0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NS0005XChiropractic ProvidersChiropractorSports Physician