Healthcare Provider Details

I. General information

NPI: 1326280231
Provider Name (Legal Business Name): TUAN VAN MAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 05/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 WASHINGTON ST STE 512
SAN DIEGO CA
92103
US

IV. Provider business mailing address

501 WASHINGTON ST STE 512
SAN DIEGO CA
92103-2238
US

V. Phone/Fax

Practice location:
  • Phone: 619-297-0014
  • Fax: 619-297-1014
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA113870
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD162045
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberA113870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: