Provider Demographics
NPI:1366526147
Name:TRINH, THOMAS TOAN (MD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:TOAN
Last Name:TRINH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4035 SW MERCANTILE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035
Mailing Address - Country:US
Mailing Address - Phone:503-675-7495
Mailing Address - Fax:503-675-7496
Practice Address - Street 1:4035 SW MERCANTILE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035
Practice Address - Country:US
Practice Address - Phone:503-675-7495
Practice Address - Fax:503-675-7496
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21038207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORMD21038OtherMEDICAL LICENSE
R108744Medicare ID - Type Unspecified
ORMD21038OtherMEDICAL LICENSE