Healthcare Provider Details

I. General information

NPI: 1013840743
Provider Name (Legal Business Name): MATTHEW MAI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17609 VENTURA BLVD STE 104
ENCINO CA
91316-5148
US

IV. Provider business mailing address

22026 CANTLAY ST
CANOGA PARK CA
91303-1101
US

V. Phone/Fax

Practice location:
  • Phone: 818-291-3636
  • Fax:
Mailing address:
  • Phone: 818-288-8064
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number37630
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: