Provider Demographics
NPI:1083049613
Name:MAI, TUONGVI (DPT)
Entity Type:Individual
Prefix:
First Name:TUONGVI
Middle Name:
Last Name:MAI
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 N MATHILDA AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-4830
Mailing Address - Country:US
Mailing Address - Phone:408-736-7600
Mailing Address - Fax:408-736-7604
Practice Address - Street 1:263 N MATHILDA AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-4830
Practice Address - Country:US
Practice Address - Phone:408-736-7600
Practice Address - Fax:408-736-7604
Is Sole Proprietor?:No
Enumeration Date:2013-09-13
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT40341225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ29361ZOtherMEDICARE GROUP PTAN
CA1053320325OtherGROUP NPI
CACA139277Medicare PIN