Provider Demographics
NPI:1417065301
Name:LUU, TRINH T (PA)
Entity type:Individual
Prefix:
First Name:TRINH
Middle Name:T
Last Name:LUU
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 GARDNER DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28405-8873
Mailing Address - Country:US
Mailing Address - Phone:910-343-5300
Mailing Address - Fax:
Practice Address - Street 1:1705 GARDNER DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28405-8873
Practice Address - Country:US
Practice Address - Phone:910-343-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
NC103698363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0823PAMedicaid
NC8101958Medicaid
NCD7256OtherMEDCOST
NCD7256OtherMEDCOST
SC0823PAMedicaid
NC2761330BMedicare PIN