MEDICARE: DR. KHANH HO UYEN TRINH DMD

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223P0106X	Oral and Maxillofacial Pathology Dentistry	063343	NY

General Provider Information

NPI Number	:	1619502051
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KHANH HO UYEN TRINH DMD

Provider Business Mailing Address
First Line	:	630 W 168TH ST PH 15W-1562
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3725
Country	:	US
Telephone Number	:	212-305-2500
Fax Number	:

Provider Business Practice Location Address
First Line	:	630 WEST 168TH STREET
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032
Country	:	US
Telephone Number	:	212-305-2500
Fax Number	:

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

Provider Enumeration Date	:	03/05/2020
Last Update Date	:	08/21/2023

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