Healthcare Provider Details

I. General information

NPI: 1912669631
Provider Name (Legal Business Name): KAYLA TRINH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 07/18/2023
Certification Date: 07/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11711 E MARKET PL STE 100
FULTON MD
20759-2595
US

IV. Provider business mailing address

11711 E MARKET PL STE 100
FULTON MD
20759-2595
US

V. Phone/Fax

Practice location:
  • Phone: 301-679-5772
  • Fax:
Mailing address:
  • Phone: 301-679-5772
  • Fax: 240-654-0408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0008616
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0008616
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberC0008616
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: