Provider Demographics
NPI:1679651582
Name:TRINH, DZUNG (MD)
Entity Type:Individual
Prefix:
First Name:DZUNG
Middle Name:
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 1:1090 E KELSO AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1849
Mailing Address - Country:US
Mailing Address - Phone:559-906-2962
Mailing Address - Fax:559-550-6011
Practice Address - Street 1:347 E BARSTOW AVE
Practice Address - Street 2:STE 102
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-6039
Practice Address - Country:US
Practice Address - Phone:559-550-4344
Practice Address - Fax:559-550-6011
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG65282207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G652820Medicaid
F45086Medicare UPIN
00G652820Medicare ID - Type Unspecified