Healthcare Provider Details

I. General information

NPI: 1063508950
Provider Name (Legal Business Name): TAI TRINH BA-SOCIOLOGY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 W METROPOLITAN DR # 120
ORANGE CA
92868-3504
US

IV. Provider business mailing address

24216 SPARKLING SPRING LN
LAKE FOREST CA
92630-3686
US

V. Phone/Fax

Practice location:
  • Phone: 714-972-9700
  • Fax: 714-972-3744
Mailing address:
  • Phone: 310-756-5248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: