MEDICARE: DR. KENNY KHIEM-HUY MAI D.O

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	006199	AZ
2	390200000X	Student in an Organized Health Care Education/Training Program	R1508	AZ
3	207R00000X	Internal Medicine Physician	20A20663	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760703623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNY KHIEM-HUY MAI D.O

Provider Business Mailing Address
First Line	:	8901 ACTIVITY RD STE 205
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-4436
Country	:	US
Telephone Number	:	858-779-9919
Fax Number	:	858-779-9219

Provider Business Practice Location Address
First Line	:	8901 ACTIVITY RD STE 205
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-4436
Country	:	US
Telephone Number	:	858-779-9919
Fax Number	:	858-779-9219

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2010
Last Update Date	:	06/05/2024

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Directions to “ DR. KENNY KHIEM-HUY MAI D.O” Practice Location

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