Healthcare Provider Details

I. General information

NPI: 1467948067
Provider Name (Legal Business Name): HUNG DUC TRINH DPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2018
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 NW NORMAN AVE
GRESHAM OR
97030-5551
US

IV. Provider business mailing address

8838 SE CLINTON ST
PORTLAND OR
97266-1461
US

V. Phone/Fax

Practice location:
  • Phone: 971-362-3288
  • Fax: 971-353-4990
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number62827
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: