Provider Demographics
NPI:1629015656
Name:NGUYEN, MAI HOANG (MD)
Entity Type:Individual
Prefix:DR
First Name:MAI
Middle Name:HOANG
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14501 MAGNOLIA ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5542
Mailing Address - Country:US
Mailing Address - Phone:714-903-8090
Mailing Address - Fax:714-903-8191
Practice Address - Street 1:14501 MAGNOLIA ST
Practice Address - Street 2:SUITE 109
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5542
Practice Address - Country:US
Practice Address - Phone:714-903-8090
Practice Address - Fax:714-903-8191
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA709502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0070750Medicaid
CA0070750Medicaid