Provider Demographics
NPI:1437485513
Name:KELVIN MAI, D.O., INC
Entity Type:Organization
Organization Name:KELVIN MAI, D.O., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:ORANTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-515-5004
Mailing Address - Street 1:1002 N FAIRVIEW ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92703-1811
Mailing Address - Country:US
Mailing Address - Phone:147-332-1069
Mailing Address - Fax:
Practice Address - Street 1:1002 N FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92703-1811
Practice Address - Country:US
Practice Address - Phone:714-332-1069
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-26
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8944261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care