Provider Demographics
NPI:1477959583
Name:LAI, MAI NGAN NGUYEN (MD)
Entity Type:Individual
Prefix:
First Name:MAI NGAN
Middle Name:NGUYEN
Last Name:LAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MAI
Other - Middle Name:NGAN
Other - Last Name:LAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1150 N INDIAN CANYON DR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-4872
Mailing Address - Country:US
Mailing Address - Phone:347-237-1546
Mailing Address - Fax:
Practice Address - Street 1:1150 N INDIAN CANYON DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4872
Practice Address - Country:US
Practice Address - Phone:347-237-1546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138564207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine