Provider Demographics
NPI:1568674539
Name:TRINH, PHUC PHAN (DDS)
Entity Type:Individual
Prefix:
First Name:PHUC
Middle Name:PHAN
Last Name:TRINH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 MCKEE RD
Mailing Address - Street 2:SUITE # 20
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95116
Mailing Address - Country:US
Mailing Address - Phone:408-678-0102
Mailing Address - Fax:408-678-0102
Practice Address - Street 1:1608 MCKEE RD
Practice Address - Street 2:SUITE # 20
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116
Practice Address - Country:US
Practice Address - Phone:408-678-0102
Practice Address - Fax:408-678-0102
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46703122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist