Provider Demographics
NPI:1770040156
Name:TRINH, KAITLYN ANH (OD)
Entity Type:Individual
Prefix:DR
First Name:KAITLYN
Middle Name:ANH
Last Name:TRINH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 DAVIS WAY
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-5236
Mailing Address - Country:US
Mailing Address - Phone:714-984-3913
Mailing Address - Fax:
Practice Address - Street 1:25360 CRENSHAW BLVD
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6121
Practice Address - Country:US
Practice Address - Phone:424-318-3726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34202TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist