Healthcare Provider Details

I. General information

NPI: 1992887293
Provider Name (Legal Business Name): VINH MAI D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 N WATERMAN AVE
SAN BERNARDINO CA
92404-4836
US

IV. Provider business mailing address

5410 MARYLAND WAY SUITE 300
BRENTWOOD TN
37027-5064
US

V. Phone/Fax

Practice location:
  • Phone: 909-881-4520
  • Fax: 909-881-4526
Mailing address:
  • Phone: 615-377-5652
  • Fax: 888-241-1404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number20A9129
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number20A9129
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number20A9129
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: