Provider Demographics
NPI:1720886138
Name:KHIEM MAI MEDICAL
Entity type:Organization
Organization Name:KHIEM MAI MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:G
Authorized Official - Last Name:MAI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-779-9919
Mailing Address - Street 1:8901 ACTIVITY RD STE 205
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4436
Mailing Address - Country:US
Mailing Address - Phone:858-779-9919
Mailing Address - Fax:858-779-9219
Practice Address - Street 1:8901 ACTIVITY RD STE 205
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4436
Practice Address - Country:US
Practice Address - Phone:858-779-9919
Practice Address - Fax:858-779-9219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty