Healthcare Provider Details

I. General information

NPI: 1740808831
Provider Name (Legal Business Name): HONG THANH MAI, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2146 E ANAHEIM ST
LONG BEACH CA
90804-3408
US

IV. Provider business mailing address

2146 E ANAHEIM ST
LONG BEACH CA
90804-3408
US

V. Phone/Fax

Practice location:
  • Phone: 562-439-7227
  • Fax: 562-439-4737
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: HONG THANH MAI
Title or Position: PRESIDENT
Credential: MD
Phone: 562-233-2273