Healthcare Provider Details

I. General information

NPI: 1255651279
Provider Name (Legal Business Name): VINH TUAN NGOC MAI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: VINH TUAN MAI M.D.

II. Dates (important events)

Enumeration Date: 06/02/2010
Last Update Date: 02/05/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 LAS COLINAS BLVD W STE 135
IRVING TX
75039-5402
US

IV. Provider business mailing address

2612 NAPLES LN
GRAND PRAIRIE TX
75052-3019
US

V. Phone/Fax

Practice location:
  • Phone: 214-574-2443
  • Fax:
Mailing address:
  • Phone: 817-715-8810
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberP7947
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberP7947
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: