Basic Information
| Provider Information | |||||||||
| NPI: | 1053609834 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIEP | ||||||||
| FirstName: | HY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2400 MOORPARK AVE | ||||||||
| Address2: | 300 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951282631 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 2400 MOORPARK AVE | ||||||||
| Address2: | 300 | ||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951282631 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4089752730 | ||||||||
| FaxNumber: | 4089752745 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/14/2011 | ||||||||
| LastUpdateDate: | 12/01/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | PSY26861 | CA | N | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103T00000X | Y | Behavioral Health & Social Service Providers | Psychologist |
No ID Information.