MEDICARE: DR. BRIAN BINH TRINH D.D.S.

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	1223G0001X	General Practice Dentistry	45626	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	B45626	OTHER	CA	DENTICAL ID

General Provider Information

NPI Number	:	1720085194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRIAN BINH TRINH D.D.S.

Provider Business Mailing Address
First Line	:	1624 FRANKLIN ST
Second Line	:	STE 910
City	:	OAKLAND
State	:	CA
Zip	:	94612-2824
Country	:	US
Telephone Number	:	510-836-4811
Fax Number	:	510-836-2338

Provider Business Practice Location Address
First Line	:	1624 FRANKLIN ST
Second Line	:	STE 910
City	:	OAKLAND
State	:	CA
Zip	:	94612-2824
Country	:	US
Telephone Number	:	510-836-4811
Fax Number	:	510-836-2338

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	10/10/2022

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