Provider Demographics
NPI:1881029205
Name:MAI, HIEN HUY (DO)
Entity Type:Individual
Prefix:
First Name:HIEN
Middle Name:HUY
Last Name:MAI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 HIGHLAND PARK BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-1639
Mailing Address - Country:US
Mailing Address - Phone:863-816-5884
Mailing Address - Fax:863-940-4856
Practice Address - Street 1:4315 HIGHLAND PARK BLVD STE A
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-1639
Practice Address - Country:US
Practice Address - Phone:863-816-5884
Practice Address - Fax:863-940-4856
Is Sole Proprietor?:No
Enumeration Date:2013-09-04
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12560207R00000X
FLUO3020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4765420OtherCIGNA
FL013551300Medicaid
FL1516HOtherBCBS
FLHZ145VOtherMEDICARE
FLP02048685OtherRR MEDICARE