Healthcare Provider Details

I. General information

NPI: 1003751652
Provider Name (Legal Business Name): MATAI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 W MCDOWELL RD
PHOENIX AZ
85007-1700
US

IV. Provider business mailing address

1102 W MCDOWELL RD
PHOENIX AZ
85007-1700
US

V. Phone/Fax

Practice location:
  • Phone: 808-386-8804
  • Fax: 808-386-8804
Mailing address:
  • Phone: 808-386-8804
  • Fax: 808-386-8804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAERE JOUNG
Title or Position: OWNER
Credential:
Phone: 808-386-8804