Provider Demographics
NPI:1679647341
Name:TRIEU, KIM-CHI THI (DDS)
Entity type:Individual
Prefix:MRS
First Name:KIM-CHI
Middle Name:THI
Last Name:TRIEU
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 N EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832
Mailing Address - Country:US
Mailing Address - Phone:714-871-8475
Mailing Address - Fax:714-871-3951
Practice Address - Street 1:301 N EUCLID ST
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832
Practice Address - Country:US
Practice Address - Phone:714-871-8475
Practice Address - Fax:714-871-3951
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA441081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB4410801OtherDENTI CAL