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General NPI Number Information
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NPI Number | 1649753849
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Entity Type | Individual
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Provider Name | JENNIFER NA T MAI DDS
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Gender | Female
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Dates
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Enumeration Date | 09/13/2018
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Last Update Date | 01/28/2021
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Provider Practice Location Address
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Address Line | 15422 CRENSHAW BLVD
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City | GARDENA
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State | CA
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Zip | 90249-4524
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Country | US
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Telephone | 310-352-4939
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Fax |
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Provider Business Mailing Address
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Address Line | 18803 ROSELLE AVE
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City | TORRANCE
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State | CA
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Zip | 90504-5616
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Country | US
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Telephone | 310-347-9072
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 103147
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License Number State | CA
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