Provider Demographics
NPI:1578868618
Name:HUYNH, MAI THI (DC, LAC)
Entity Type:Individual
Prefix:
First Name:MAI
Middle Name:THI
Last Name:HUYNH
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10131 WESTMINSTER AVE
Mailing Address - Street 2:SUITE #208
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-4752
Mailing Address - Country:US
Mailing Address - Phone:714-537-0988
Mailing Address - Fax:
Practice Address - Street 1:10131 WESTMINSTER AVE
Practice Address - Street 2:SUITE #208
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-4752
Practice Address - Country:US
Practice Address - Phone:714-537-0988
Practice Address - Fax:714-537-0988
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24420111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor