Provider Demographics
NPI:1295718054
Name:TRINH, TRONG QVANG (DO)
Entity type:Individual
Prefix:
First Name:TRONG
Middle Name:QVANG
Last Name:TRINH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363-0187
Mailing Address - Country:US
Mailing Address - Phone:209-892-9100
Mailing Address - Fax:209-892-9102
Practice Address - Street 1:1108 WARD AVE
Practice Address - Street 2:BLDG A STE 1
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363-8529
Practice Address - Country:US
Practice Address - Phone:209-892-9100
Practice Address - Fax:209-892-9102
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7445207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABT6358685OtherDEA CERT
CAH02271Medicare UPIN