Healthcare Provider Details

I. General information

NPI: 1164926028
Provider Name (Legal Business Name): MINH VAN TRINH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 07/31/2024
Certification Date: 01/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 3RD ST NE STE 200
AUBURN WA
98002-4035
US

IV. Provider business mailing address

125 3RD ST NE STE 200
AUBURN WA
98002-4035
US

V. Phone/Fax

Practice location:
  • Phone: 253-275-1000
  • Fax:
Mailing address:
  • Phone: 253-275-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number56970
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35.145114
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License NumberIMLC.MD.61517591
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: