Provider Demographics
NPI:1528610870
Name:MAI, JOSEPHINE HOA NGOC (PA-C)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:HOA NGOC
Last Name:MAI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HOA
Other - Middle Name:NGOC
Other - Last Name:MAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4058 WILLOWS RD
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:CA
Mailing Address - Zip Code:91901-1668
Mailing Address - Country:US
Mailing Address - Phone:619-445-1188
Mailing Address - Fax:619-659-3140
Practice Address - Street 1:4058 WILLOWS RD
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:CA
Practice Address - Zip Code:91901-1668
Practice Address - Country:US
Practice Address - Phone:619-445-1188
Practice Address - Fax:619-659-3140
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA58572363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical