Provider Demographics
NPI:1487179743
Name:MAI, SU MEI
Entity Type:Individual
Prefix:
First Name:SU MEI
Middle Name:
Last Name:MAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3745 FREDRICKSBURG ST APT B
Mailing Address - Street 2:
Mailing Address - City:FORT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310-1701
Mailing Address - Country:US
Mailing Address - Phone:270-798-8751
Mailing Address - Fax:
Practice Address - Street 1:3745 FREDRICKSBURG ST APT B
Practice Address - Street 2:
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310-1701
Practice Address - Country:US
Practice Address - Phone:270-798-8751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-08
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101839122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist