Provider Demographics
NPI:1346300191
Name:MAI, VICKY NINH (DO)
Entity Type:Individual
Prefix:DR
First Name:VICKY
Middle Name:NINH
Last Name:MAI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4310 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-3829
Mailing Address - Country:US
Mailing Address - Phone:951-781-6335
Mailing Address - Fax:951-208-7244
Practice Address - Street 1:4244 RIVERWALK PKWY STE 150
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3373
Practice Address - Country:US
Practice Address - Phone:951-781-6335
Practice Address - Fax:951-781-6365
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7549207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEE804ZMedicare PIN
CAEE804YMedicare PIN