Basic Information
| Provider Information | |||||||||
| NPI: | 1427032952 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRINH | ||||||||
| FirstName: | CHANNHU | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2933 MAGINN DR | ||||||||
| Address2: | |||||||||
| City: | BEAVERCREEK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454345831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7406443037 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3371 KEMP RD | ||||||||
| Address2: | |||||||||
| City: | BEAVERCREEK | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454312514 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374584200 | ||||||||
| FaxNumber: | 9374584209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2005 | ||||||||
| LastUpdateDate: | 04/05/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 01048969A | IN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 35087874 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | P01034947 | 01 | RAILROAD MEDICARE PIN | OTHER | 200335580 | 05 | IN | MEDICAID | 2663667 | 05 | OH | MEDICAID |