Healthcare Provider Details

I. General information

NPI: 1972579852
Provider Name (Legal Business Name): TRIEU P HUA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 11/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 BUCKLES COURT NORTH SUITE 100
GAHANNA OH
43230
US

IV. Provider business mailing address

725 BUCKLES COURT NORTH SUITE 100
GAHANNA OH
43230
US

V. Phone/Fax

Practice location:
  • Phone: 614-471-9654
  • Fax: 614-392-4586
Mailing address:
  • Phone: 614-471-9654
  • Fax: 614-392-4586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35-067480
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: