Provider Demographics
NPI:1649601931
Name:MAI, KIMBERLY GIANG (LVN)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:GIANG
Last Name:MAI
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5815 E LA PALMA AVE SPC 161
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-2253
Mailing Address - Country:US
Mailing Address - Phone:714-904-6944
Mailing Address - Fax:
Practice Address - Street 1:5815 E LA PALMA AVE SPC 161
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-2253
Practice Address - Country:US
Practice Address - Phone:714-904-6944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-11
Last Update Date:2014-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN236442164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse