MEDICARE: KIEU THANH DINH

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	103K00000X	Behavior Analyst	1-24-75048	GA

General Provider Information

NPI Number	:	1831923374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIEU THANH DINH

Provider Business Mailing Address
First Line	:	3005 BRECKINRIDGE BLVD STE 230
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-4978
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3005 BRECKINRIDGE BLVD STE 230
Second Line	:
City	:	DULUTH
State	:	GA
Zip	:	30096-4978
Country	:	US
Telephone Number	:	404-410-7600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/28/2024
Last Update Date	:	08/28/2024

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Directions to “ KIEU THANH DINH ” Practice Location

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