Provider Demographics
NPI:1952890113
Name:MAI, KEVIN (DO)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
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 1:16111 BEACH BLVD STE A1
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-3804
Mailing Address - Country:US
Mailing Address - Phone:714-596-0368
Mailing Address - Fax:714-591-8265
Practice Address - Street 1:16111 BEACH BLVD STE A1
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3804
Practice Address - Country:US
Practice Address - Phone:714-596-0368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A17954207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine