Provider Demographics
NPI:1578223202
Name:VANG, MAI N
Entity Type:Individual
Prefix:
First Name:MAI
Middle Name:N
Last Name:VANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAI
Other - Middle Name:N
Other - Last Name:VANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MAI
Mailing Address - Street 1:1025 ATLANTIC AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-1188
Mailing Address - Country:US
Mailing Address - Phone:510-268-8120
Mailing Address - Fax:
Practice Address - Street 1:1025 ATLANTIC AVE STE 101
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-1188
Practice Address - Country:US
Practice Address - Phone:510-268-8120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician