Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NR0400X | Rehabilitation Chiropractor | 34463 | CA |
NPI | 1063979045 |
---|---|
Provider Name | Thai Mai |
First Address | Garden Grove, CA 92840-2115 |
Second Address | Garden Grove, CA 92841-1823 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2019 |
Last Update Date | 26/02/2019 |