MEDICARE: DIANAPHARM LLC

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	333600000X	Pharmacy	PHY46838	CA
2	3336C0003X	Community/Retail Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5613915	OTHER		OTHER ID NUMBER-COMMERCIAL NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881605384
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIANAPHARM LLC

Provider Business Mailing Address
First Line	:	3545 WILSHIRE BLVD
Second Line	:	STE 200
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2354
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3545 WILSHIRE BLVD
Second Line	:	STE 200
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-2354
Country	:	US
Telephone Number	:	213-385-2135
Fax Number	:	213-385-2138

Authorized Official
Title or Position	:	OWNER
Name	:	HYO LEE
Credential	:
Telephone Number	:	213-385-2135

Provider Enumeration Date	:	08/10/2006
Last Update Date	:	06/13/2008

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Directions to “DIANAPHARM LLC ” Practice Location

Language	Start Address	Practice Location

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