Provider Demographics
NPI:1982668190
Name:MAI, QUYNH MINH (MD)
Entity Type:Individual
Prefix:
First Name:QUYNH
Middle Name:MINH
Last Name:MAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 W ESPLANADE AVE
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-2867
Mailing Address - Country:US
Mailing Address - Phone:504-465-0185
Mailing Address - Fax:504-467-1528
Practice Address - Street 1:708 W ESPLANADE AVE
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065
Practice Address - Country:US
Practice Address - Phone:504-465-0185
Practice Address - Fax:504-467-1528
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA024314207Q00000X
LA24314207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1448940Medicaid
LAH09299Medicare UPIN
LA5H048Medicare PIN