Healthcare Provider Details

I. General information

NPI: 1093895674
Provider Name (Legal Business Name): TOQUYNH DINH KIEU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 WARNER AVE SUITE # 116
FOUNTAIN VALLEY CA
92708-7506
US

IV. Provider business mailing address

11100 WARNER AVE SUITE # 116
FOUNTAIN VALLEY CA
92708-7506
US

V. Phone/Fax

Practice location:
  • Phone: 714-641-0850
  • Fax: 714-434-6158
Mailing address:
  • Phone: 714-641-0850
  • Fax: 714-434-6158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA31746
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: