Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | A033477 | CA |
NPI | 1376883975 |
---|---|
Provider Name | Dr. Su Mai |
First Address | Garden Grove, CA 92843-1024 |
Second Address | Garden Grove, CA 92843-1024 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/02/2013 |
Last Update Date | 20/02/2013 |