Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | E4793 | CA |
NPI | 1023258415 |
---|---|
Provider Name | Cong Thanh Mai |
First Address | Huntington Beach, CA 92648-2050 |
Second Address | Visalia, CA 93291-8222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/02/2009 |
Last Update Date | 05/10/2018 |