Healthcare Provider Details

I. General information

NPI: 1639563612
Provider Name (Legal Business Name): HONG-DAO MAI RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2015
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 E 17TH ST
COSTA MESA CA
92627-3252
US

IV. Provider business mailing address

9300 HEATHER AVE
FOUNTAIN VALLEY CA
92708-1922
US

V. Phone/Fax

Practice location:
  • Phone: 949-645-1277
  • Fax:
Mailing address:
  • Phone: 714-454-4616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number64418
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: