=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407305006
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANDY N. TRINH DDS PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2016
-----------------------------------------------------
Last Update Date | 09/25/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12537 116TH AVE NE
-----------------------------------------------------
City | KIRKLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98034-4310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-820-1820
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12537 116TH AVE NE
-----------------------------------------------------
City | KIRKLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98034-4310
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 425-820-1820
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. ANDY TRINH
-----------------------------------------------------
Credential | D.D.S.
-----------------------------------------------------
Telephone | 206-218-7740
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | DE 60373467
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------