MEDICARE: DIANA XA D.D.S., INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	38944	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346399417
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIANA XA D.D.S., INC.

Provider Business Mailing Address
First Line	:	7154 EDINGER AVE
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-3505
Country	:	US
Telephone Number	:	714-847-7800
Fax Number	:	714-847-4010

Provider Business Practice Location Address
First Line	:	7154 EDINGER AVE
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92647-3505
Country	:	US
Telephone Number	:	714-847-7800
Fax Number	:	714-847-4010

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DIANA TU-DIEU XA
Credential	:
Telephone Number	:	714-847-7800

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	08/22/2020

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