Provider Demographics
NPI:1275875619
Name:MAI, VICTOR VU (DMD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:VU
Last Name:MAI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:VU
Other - Middle Name:
Other - Last Name:MAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:25401 ALICIA PKWY
Mailing Address - Street 2:SUITE J
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4958
Mailing Address - Country:US
Mailing Address - Phone:949-587-3010
Mailing Address - Fax:949-215-3757
Practice Address - Street 1:25401 ALICIA PKWY
Practice Address - Street 2:SUITE J
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-4958
Practice Address - Country:US
Practice Address - Phone:949-587-3010
Practice Address - Fax:949-215-3757
Is Sole Proprietor?:No
Enumeration Date:2013-03-24
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA638791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice