Provider Demographics
NPI:1376883975
Name:MAI, SU (MD)
Entity Type:Individual
Prefix:DR
First Name:SU
Middle Name:
Last Name:MAI
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:13071 BROOKHURST ST STE 150
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1024
Mailing Address - Country:US
Mailing Address - Phone:714-530-3340
Mailing Address - Fax:714-530-3345
Practice Address - Street 1:13071 BROOKHURST ST STE 150
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1024
Practice Address - Country:US
Practice Address - Phone:714-530-3340
Practice Address - Fax:714-530-3345
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-20
Last Update Date:2013-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA033477207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery