Provider Demographics
NPI:1811201916
Name:TRINH, KHANH NGHI (OD)
Entity Type:Individual
Prefix:
First Name:KHANH
Middle Name:NGHI
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 1:12656 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-6240
Mailing Address - Country:US
Mailing Address - Phone:225-751-4100
Mailing Address - Fax:225-751-4103
Practice Address - Street 1:12656 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-6240
Practice Address - Country:US
Practice Address - Phone:225-751-4100
Practice Address - Fax:225-751-4103
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1601-634T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2128591Medicaid
LA1601-634TOtherLOUISIANA STATE LICENSE
LA1601-634TOtherLOUISIANA STATE LICENSE