Healthcare Provider Details

I. General information

NPI: 1902305824
Provider Name (Legal Business Name): DIEP HONG EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2018
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28241 MOUND RD
WARREN MI
48092-5523
US

IV. Provider business mailing address

28241 MOUND RD
WARREN MI
48092-5523
US

V. Phone/Fax

Practice location:
  • Phone: 989-401-2244
  • Fax:
Mailing address:
  • Phone: 989-401-2244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7401001030
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: