Provider Demographics
NPI:1407077829
Name:TRINH, DIEM THI (MD)
Entity Type:Individual
Prefix:DR
First Name:DIEM
Middle Name:THI
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 1:6620 108TH ST
Mailing Address - Street 2:APT 2M
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2251
Mailing Address - Country:US
Mailing Address - Phone:718-459-5916
Mailing Address - Fax:
Practice Address - Street 1:250 W 57TH ST
Practice Address - Street 2:SUITE 825
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10107-0001
Practice Address - Country:US
Practice Address - Phone:212-489-6669
Practice Address - Fax:212-265-7685
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY210834207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH72676Medicare UPIN
A400014231Medicare PIN