Provider Demographics
NPI:1609995265
Name:TRIMBLE, ATITAYA TAHN (MD)
Entity Type:Individual
Prefix:DR
First Name:ATITAYA
Middle Name:TAHN
Last Name:TRIMBLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ATITAYA
Other - Middle Name:
Other - Last Name:VEERASETHAKUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:217 ELM TREE LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40507-2117
Mailing Address - Country:US
Mailing Address - Phone:859-257-8801
Mailing Address - Fax:
Practice Address - Street 1:217 ELM TREE LN
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40507-2117
Practice Address - Country:US
Practice Address - Phone:859-257-8801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH57010610207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine