Healthcare Provider Details

I. General information

NPI: 1255953774
Provider Name (Legal Business Name): PETER VIET-QUOC MAI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: PETER VIET-QUOC NGUYEN MD

II. Dates (important events)

Enumeration Date: 05/07/2020
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 FLORIDA AVE STE 102
MODESTO CA
95350-4446
US

IV. Provider business mailing address

1400 FLORIDA AVE STE 102
MODESTO CA
95350-4446
US

V. Phone/Fax

Practice location:
  • Phone: 714-623-4459
  • Fax:
Mailing address:
  • Phone: 714-623-4459
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: