Provider Demographics
NPI:1417023029
Name:MAI, NHAT VAN (MD)
Entity Type:Individual
Prefix:
First Name:NHAT
Middle Name:VAN
Last Name:MAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NHAT
Other - Middle Name:VAN
Other - Last Name:MAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:636 E SANTA CLARA ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-1902
Mailing Address - Country:US
Mailing Address - Phone:408-294-1990
Mailing Address - Fax:408-294-9093
Practice Address - Street 1:636 E SANTA CLARA ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-1902
Practice Address - Country:US
Practice Address - Phone:408-294-1990
Practice Address - Fax:408-294-9093
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45584207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine