1558642660 NPI number — DR. KIM MINH THI DIEP PHARM.D.

Table of content: SARAH L TUTTLE (NPI 1306091962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558642660 NPI number — DR. KIM MINH THI DIEP PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIEP
Provider First Name:
KIM
Provider Middle Name:
MINH THI
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIEP
Provider Other First Name:
KIM
Provider Other Middle Name:
MINH
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARM.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1558642660
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2050 CALIFORNIA ST
Provider Second Line Business Mailing Address:
APT #11
Provider Business Mailing Address City Name:
MOUNTAIN VIEW
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94040-1771
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-943-4805
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3801 MIRANDA AVE
Provider Second Line Business Practice Location Address:
(119)
Provider Business Practice Location Address City Name:
PALO ALTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94304-1207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-493-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/01/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  65989 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)