Provider Demographics
NPI:1063689842
Name:TRINH, KIM (MD)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:TRINH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LONG
Other - Middle Name:KIM
Other - Last Name:TRINH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7922 DAY CREEK BLVD
Mailing Address - Street 2:APT 5112
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-8584
Mailing Address - Country:US
Mailing Address - Phone:951-333-1581
Mailing Address - Fax:
Practice Address - Street 1:9961 SIERRA AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-6720
Practice Address - Country:US
Practice Address - Phone:951-333-1581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-12
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108396207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine