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General NPI Number Information
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NPI Number | 1245862887
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Entity Type | Individual
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Provider Name | DENNIS TRIEU
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Gender | Male
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Dates
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Enumeration Date | 02/11/2020
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Last Update Date | 02/11/2020
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Provider Practice Location Address
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Address Line | 652 N BROADWAY
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City | LOS ANGELES
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State | CA
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Zip | 90012-2802
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Country | US
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Telephone | 213-617-7673
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Fax |
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Provider Business Mailing Address
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Address Line | 318 N NICHOLSON AVE APT 2
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City | MONTEREY PARK
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State | CA
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Zip | 91755-1874
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Country | US
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Telephone | 626-278-9588
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | PA57802
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License Number State | CA
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