MEDICARE: TRI HO

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	PA67787	CA

General Provider Information

NPI Number	:	1508750019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRI HO

Provider Business Mailing Address
First Line	:	12665 GARDEN GROVE BLVD
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-1901
Country	:	US
Telephone Number	:	657-342-5629
Fax Number	:

Provider Business Practice Location Address
First Line	:	12665 GARDEN GROVE BLVD
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92843-1901
Country	:	US
Telephone Number	:	657-342-5629
Fax Number	:

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

Provider Enumeration Date	:	06/07/2025
Last Update Date	:	06/24/2026

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Directions to “ TRI HO ” Practice Location

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