Healthcare Provider Details

I. General information

NPI: 1205756830
Provider Name (Legal Business Name): KHANH LINH DIEP
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5241 CENTER BLVD APT 2905
LONG ISLAND CITY NY
11101-6558
US

IV. Provider business mailing address

5241 CENTER BLVD APT 2905
LONG ISLAND CITY NY
11101-6558
US

V. Phone/Fax

Practice location:
  • Phone: 415-949-8881
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number132268
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: