Healthcare Provider Details

I. General information

NPI: 1770374266
Provider Name (Legal Business Name): THANH HUY MAI NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4634 MUSCATEL AVE
ROSEMEAD CA
91770-1269
US

IV. Provider business mailing address

4634 MUSCATEL AVE
ROSEMEAD CA
91770-1269
US

V. Phone/Fax

Practice location:
  • Phone: 626-349-5425
  • Fax:
Mailing address:
  • Phone: 626-349-5425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95038089
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95112113
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: