Provider Demographics
NPI:1114958808
Name:TRINH, KHIET (MD)
Entity Type:Individual
Prefix:
First Name:KHIET
Middle Name:
Last Name:TRINH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4306 WELBY DR
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-3656
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5801 BREMO RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1907
Practice Address - Country:US
Practice Address - Phone:804-389-3508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD072204L207Q00000X
VA0101253600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50051118OtherBLUE CROSS
PAP002502OtherGATEWAY
PA7732271OtherAETNA
PA000000168257OtherUNISON
PA0018404800002Medicaid
VAC09633OtherGROUP PTAN
PAP00278113OtherRR MEDICARE
PA921815OtherBLUE SHIELD
PA921815OtherBLUE SHIELD
H35336Medicare UPIN