Provider Demographics
NPI:1265439343
Name:MAI, PHUONG XUAN (MD)
Entity type:Individual
Prefix:DR
First Name:PHUONG
Middle Name:XUAN
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 1:6620 KEENE DR
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-2508
Mailing Address - Country:US
Mailing Address - Phone:703-598-5910
Mailing Address - Fax:703-639-0738
Practice Address - Street 1:6620 KEENE DR
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-2508
Practice Address - Country:US
Practice Address - Phone:703-598-5910
Practice Address - Fax:703-639-0738
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233304208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010135796Medicaid
VAH90658Medicare UPIN
VA010135796Medicaid