MEDICARE: HALEY TRINH PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	58253	CA

General Provider Information

NPI Number	:	1407488638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY TRINH PA-C

Provider Business Mailing Address
First Line	:	9454 WILSHIRE BLVD STE 108A
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-2931
Country	:	US
Telephone Number	:	310-772-0766
Fax Number	:

Provider Business Practice Location Address
First Line	:	9454 WILSHIRE BLVD STE 108A
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-2931
Country	:	US
Telephone Number	:	310-772-0766
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/05/2020
Last Update Date	:	10/20/2021

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