MEDICARE: TIEN 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	G79654	CA

General Provider Information

NPI Number	:	1881791135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIEN TRINH M.D.

Provider Business Mailing Address
First Line	:	728 COLLEEN DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95123-4605
Country	:	US
Telephone Number	:	408-809-7533
Fax Number	:	408-809-7539

Provider Business Practice Location Address
First Line	:	728 COLLEEN DR
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95123-4605
Country	:	US
Telephone Number	:	408-809-7533
Fax Number	:	408-809-7539

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	05/24/2016

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