Healthcare Provider Details

I. General information

NPI: 1104768456
Provider Name (Legal Business Name): KIM DIEP NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21035 SYCOLIN RD STE 180
ASHBURN VA
20147-4311
US

IV. Provider business mailing address

14719 TOP SERGEANT LN
CENTREVILLE VA
20121-2573
US

V. Phone/Fax

Practice location:
  • Phone: 703-783-5673
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024196678
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: