Healthcare Provider Details

I. General information

NPI: 1619897832
Provider Name (Legal Business Name): CHARLES DOAN MAI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

453 N DAISY AVE
PASADENA CA
91107-2810
US

IV. Provider business mailing address

453 N DAISY AVE
PASADENA CA
91107-2810
US

V. Phone/Fax

Practice location:
  • Phone: 626-353-0355
  • Fax:
Mailing address:
  • Phone: 626-353-0355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number158109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: