Healthcare Provider Details

I. General information

NPI: 1508383654
Provider Name (Legal Business Name): THIEN T HONG DIEP RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13222 BLOOMFIELD AVE
NORWALK CA
90650-3249
US

IV. Provider business mailing address

4823 WALNUT AVE
LONG BEACH CA
90807-1236
US

V. Phone/Fax

Practice location:
  • Phone: 562-207-0745
  • Fax:
Mailing address:
  • Phone: 408-896-1606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number95078837
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number95078837
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: