Provider Demographics
NPI:1962426064
Name:MAI, KENNY T (MD,)
Entity type:Individual
Prefix:DR
First Name:KENNY
Middle Name:T
Last Name:MAI
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Gender:M
Credentials:MD,
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Mailing Address - Street 1:PO BOX 1329
Mailing Address - Street 2:
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93232-1329
Mailing Address - Country:US
Mailing Address - Phone:559-582-9621
Mailing Address - Fax:559-582-9622
Practice Address - Street 1:870 W. SEVENTH STREET
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230
Practice Address - Country:US
Practice Address - Phone:559-582-9621
Practice Address - Fax:559-582-9622
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2014-07-09
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Provider Licenses
StateLicense IDTaxonomies
CAA96023207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI61584Medicare UPIN