Provider Demographics
NPI:1255197026
Name:MAI, XUYEN KIM
Entity type:Individual
Prefix:DR
First Name:XUYEN
Middle Name:KIM
Last Name:MAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13191 NINA PL
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1305
Mailing Address - Country:US
Mailing Address - Phone:714-902-7579
Mailing Address - Fax:
Practice Address - Street 1:600 CITY PKWY W STE 1000
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-2968
Practice Address - Country:US
Practice Address - Phone:800-708-3230
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA89245183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist