Healthcare Provider Details

I. General information

NPI: 1508118530
Provider Name (Legal Business Name): TRINA THAI PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2012
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12440 BROOKHURST ST
GARDEN GROVE CA
92840-4712
US

IV. Provider business mailing address

12440 BROOKHURST ST
GARDEN GROVE CA
92840-4712
US

V. Phone/Fax

Practice location:
  • Phone: 714-537-8099
  • Fax: 714-537-8917
Mailing address:
  • Phone: 714-537-8099
  • Fax: 714-537-8917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number62090
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: