Provider Demographics
NPI:1679032783
Name:TRINH, TIEN LE HOANG (PTA)
Entity Type:Individual
Prefix:
First Name:TIEN
Middle Name:LE HOANG
Last Name:TRINH
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1350 OAKLAND RD SPC 39
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-1323
Mailing Address - Country:US
Mailing Address - Phone:408-643-3050
Mailing Address - Fax:
Practice Address - Street 1:373 PINE LN
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1694
Practice Address - Country:US
Practice Address - Phone:650-948-8291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPTA49820225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant