Provider Demographics
NPI:1093754376
Name:TRINH, PHUONG NGOC (MD)
Entity Type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:NGOC
Last Name:TRINH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5008 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-2707
Mailing Address - Country:US
Mailing Address - Phone:215-455-5403
Mailing Address - Fax:215-455-7615
Practice Address - Street 1:5008 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-2707
Practice Address - Country:US
Practice Address - Phone:215-455-5403
Practice Address - Fax:215-455-7615
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-05
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD033324E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1008344Medicaid
PA121804Medicare ID - Type Unspecified
PAB37221Medicare UPIN