Basic Information
Provider Information
NPI: 1356423396
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: TRINH
FirstName: KIM
MiddleName: ANH
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2742 DOW AVE
Address2:  
City: TUSTIN
State: CA
PostalCode: 927807242
CountryCode: US
TelephoneNumber: 7146651600
FaxNumber:  
Practice Location
Address1: 11420 WARNER AVE
Address2:  
City: FOUNTAIN VALLEY
State: CA
PostalCode: 927082529
CountryCode: US
TelephoneNumber: 7145491300
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/19/2006
LastUpdateDate: 03/19/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XA87296CAY Allopathic & Osteopathic PhysiciansInternal Medicine 

No ID Information.


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