Healthcare Provider Details

I. General information

NPI: 1154542025
Provider Name (Legal Business Name): VINH XUAN MAI DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 E SHIELDS AVE SUITE 226
FRESNO CA
93726
US

IV. Provider business mailing address

6700 AUBURN STREET APT 93
BAKERSFIELD CA
93330
US

V. Phone/Fax

Practice location:
  • Phone: 559-226-2626
  • Fax:
Mailing address:
  • Phone: 661-873-9382
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number49371
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: