Provider Demographics
NPI:1770943177
Name:TRINH, JENNIFER DUYEN (DO)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DUYEN
Last Name:TRINH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8325 WHITLEY RD STE 100
Mailing Address - Street 2:
Mailing Address - City:WATAUGA
Mailing Address - State:TX
Mailing Address - Zip Code:76148-2493
Mailing Address - Country:US
Mailing Address - Phone:480-334-4222
Mailing Address - Fax:
Practice Address - Street 1:8325 WHITLEY RD STE 100
Practice Address - Street 2:
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-2493
Practice Address - Country:US
Practice Address - Phone:817-479-1181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-26
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR5484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine