MEDICARE: CHUONG VAN TRINH M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	MD034771E	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255375523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHUONG VAN TRINH M.D

Provider Business Mailing Address
First Line	:	5920 N 5TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-1824
Country	:	US
Telephone Number	:	215-548-5099
Fax Number	:	215-548-5296

Provider Business Practice Location Address
First Line	:	5920 N 5TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19120-1824
Country	:	US
Telephone Number	:	215-548-5099
Fax Number	:	215-548-5296

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	08/20/2012

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