Basic Information
| Provider Information | |||||||||
| NPI: | 1144503152 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LE | ||||||||
| FirstName: | TRINH | ||||||||
| MiddleName: | T.H. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1229 C AVE E | ||||||||
| Address2: | |||||||||
| City: | OSKALOOSA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 525774298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6416723394 | ||||||||
| FaxNumber: | 6416723336 | ||||||||
| Practice Location | |||||||||
| Address1: | 1229 C AVE E | ||||||||
| Address2: | |||||||||
| City: | OSKALOOSA | ||||||||
| State: | IA | ||||||||
| PostalCode: | 525774298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6416723394 | ||||||||
| FaxNumber: | 6416723336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2011 | ||||||||
| LastUpdateDate: | 01/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 01/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD-49220 | IA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 4301095429 | MI | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1639578537 | 01 | MI | IRS | OTHER |