Provider Demographics
NPI:1083292445
Name:MAI, DANIEL DUONG (DO)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:DUONG
Last Name:MAI
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:DANIEL MAI
Mailing Address - Street 2:1 UNIVERSITY OF NEW MEXICO MSC10 5550
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-6331
Mailing Address - Fax:505-272-0475
Practice Address - Street 1:DANIEL MAI
Practice Address - Street 2:1 UNIVERSITY OF NEW MEXICO MSC10 5550
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87131-0001
Practice Address - Country:US
Practice Address - Phone:505-272-6331
Practice Address - Fax:505-272-0475
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program