Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | G57605 | CA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | G57605 | CA |
NPI | 1124025598 |
---|---|
Provider Name | Michael T. Mai |
First Address | Corona, CA 92883-6100 |
Second Address | Corona, CA 92883-6100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/06/2005 |
Last Update Date | 24/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1730180415 | GROUP NPI (01) | CA |
200040738 | RAILROAD (01) | CA |
F02335 | (02) | CA |