Basic Information
| Provider Information | |||||||||
| NPI: | 1447581301 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRINH | ||||||||
| FirstName: | VINH | ||||||||
| MiddleName: | TRAN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | D.O. | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 920 DOUG WHITE DR STE 250 | ||||||||
| Address2: | |||||||||
| City: | MYRTLE BEACH | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295724120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8432361950 | ||||||||
| FaxNumber: | 8432361952 | ||||||||
| Practice Location | |||||||||
| Address1: | 920 DOUG WHITE DR STE 250 | ||||||||
| Address2: | |||||||||
| City: | MYRTLE BEACH | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295724120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8432361950 | ||||||||
| FaxNumber: | 8432361952 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/15/2010 | ||||||||
| LastUpdateDate: | 02/22/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 02/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208M00000X | TL1665 | SC | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | OS014441 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | OS014441 | PA | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | 1665 | SC | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1024827520001 | 05 | PA | MEDICAID |