Provider Demographics
NPI:1528042090
Name:MAI, VIET QUOC (MD)
Entity Type:Individual
Prefix:DR
First Name:VIET
Middle Name:QUOC
Last Name:MAI
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1446 SUMMITRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-4331
Mailing Address - Country:US
Mailing Address - Phone:909-861-1582
Mailing Address - Fax:
Practice Address - Street 1:520 W BADILLO ST
Practice Address - Street 2:SUITE E
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91722-3762
Practice Address - Country:US
Practice Address - Phone:626-858-5730
Practice Address - Fax:626-966-0430
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-30
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA82432208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4887735Medicare UPIN