Healthcare Provider Details

I. General information

NPI: 1801009352
Provider Name (Legal Business Name): KIMTHU TRINH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 01/28/2020
Certification Date: 01/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4565 RUFFNER ST STE 101
SAN DIEGO CA
92111-2258
US

IV. Provider business mailing address

4565 RUFFNER ST STE 101
SAN DIEGO CA
92111-2258
US

V. Phone/Fax

Practice location:
  • Phone: 858-717-4196
  • Fax: 858-724-3800
Mailing address:
  • Phone: 858-717-4196
  • Fax: 858-724-3800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: