Provider Demographics
NPI:1558363697
Name:TRINH, THAI QUOC (MD)
Entity Type:Individual
Prefix:MR
First Name:THAI
Middle Name:QUOC
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 1:7374 BERKSHIRE DOWNS DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27616-5636
Mailing Address - Country:US
Mailing Address - Phone:919-602-7428
Mailing Address - Fax:
Practice Address - Street 1:7374 BERKSHIRE DOWNS DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27616-5636
Practice Address - Country:US
Practice Address - Phone:919-602-7428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2008-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD5207207Q00000X
NC200501746207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5611560Medicaid
SDS41520Medicare ID - Type Unspecified
SDH95873Medicare UPIN
NC2048833Medicare ID - Type Unspecified