Healthcare Provider Details

I. General information

NPI: 1609186832
Provider Name (Legal Business Name): TRI-VALLEY MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2010
Last Update Date: 04/23/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39765 DATE STREET SUITE 102
MURRIETA CA
92563-2005
US

IV. Provider business mailing address

39765 DATE STREET SUITE 102
MURRIETA CA
92563-2005
US

V. Phone/Fax

Practice location:
  • Phone: 951-894-4665
  • Fax: 951-894-5178
Mailing address:
  • Phone: 951-894-4665
  • Fax: 951-894-5178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN HOANG DINH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: M.D.
Phone: 951-200-1665