Basic Information
| Provider Information | |||||||||
| NPI: | 1801092051 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRIEU | ||||||||
| FirstName: | KEVIN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 175 E CHESTER PIKE | ||||||||
| Address2: | |||||||||
| City: | RIDLEY PARK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190782212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6105956586 | ||||||||
| FaxNumber: | 6105956787 | ||||||||
| Practice Location | |||||||||
| Address1: | 4755 OGLETOWN STANTON RD STE 5A43 | ||||||||
| Address2: | |||||||||
| City: | NEWARK | ||||||||
| State: | DE | ||||||||
| PostalCode: | 197182200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3026230188 | ||||||||
| FaxNumber: | 3027335640 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2007 | ||||||||
| LastUpdateDate: | 03/16/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD432055 | PA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | C1-0010189 | DE | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | C1-0010189 | DE | N | Allopathic & Osteopathic Physicians | Hospitalist | 208M00000X | MD432055 | PA | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 102304518 | 05 | PA | MEDICAID |