Healthcare Provider Details

I. General information

NPI: 1306333646
Provider Name (Legal Business Name): MO MONG MAI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2018
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6938 W LINEBAUGH AVE STE 101
TAMPA FL
33625-5824
US

IV. Provider business mailing address

6938 W LINEBAUGH AVE STE 101
TAMPA FL
33625-5824
US

V. Phone/Fax

Practice location:
  • Phone: 813-920-0094
  • Fax: 813-767-0783
Mailing address:
  • Phone: 813-920-0094
  • Fax: 813-767-0783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME165182
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: