Provider Demographics
NPI:1215001904
Name:MAI, ANN LAN (MD)
Entity type:Individual
Prefix:DR
First Name:ANN
Middle Name:LAN
Last Name:MAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 13279
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92658-5091
Mailing Address - Country:US
Mailing Address - Phone:949-262-9700
Mailing Address - Fax:949-262-0700
Practice Address - Street 1:4950 BARRANCA PKWY STE 207
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-8648
Practice Address - Country:US
Practice Address - Phone:949-262-9700
Practice Address - Fax:949-262-0700
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61491207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A61491Medicare ID - Type Unspecified