Provider Demographics
NPI:1871649897
Name:DIEP, CYNTHIA P (DDS)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:P
Last Name:DIEP
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD STE 238
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:310-301-8707
Mailing Address - Fax:
Practice Address - Street 1:2336 SANTA MONICA BLVD STE 301
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2067
Practice Address - Country:US
Practice Address - Phone:310-998-9118
Practice Address - Fax:626-286-9663
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374101223S0112X
CA14984171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No171100000XOther Service ProvidersAcupuncturist