Healthcare Provider Details

I. General information

NPI: 1811770134
Provider Name (Legal Business Name): DANIEL MAI PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

999 N TUSTIN AVE STE 216
SANTA ANA CA
92705-6506
US

IV. Provider business mailing address

999 N TUSTIN AVE STE 216
SANTA ANA CA
92705-6506
US

V. Phone/Fax

Practice location:
  • Phone: 805-621-7651
  • Fax:
Mailing address:
  • Phone: 714-545-5550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberPA637725
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA63725
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: