Provider Demographics
NPI:1518957596
Name:MAI, CHRISTOPHER CHIEN (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:CHIEN
Last Name:MAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:821 STATE ROAD 44
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7271
Mailing Address - Country:US
Mailing Address - Phone:386-427-3767
Mailing Address - Fax:386-423-2516
Practice Address - Street 1:821 STATE ROAD 44
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7271
Practice Address - Country:US
Practice Address - Phone:386-427-3767
Practice Address - Fax:386-423-2516
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME80709207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259288600Medicaid
H26430Medicare UPIN
35666Medicare ID - Type Unspecified