Provider Demographics
NPI:1962588368
Name:MAI, TOLAN NGUYEN (DC)
Entity type:Individual
Prefix:DR
First Name:TOLAN
Middle Name:NGUYEN
Last Name:MAI
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 S HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-2337
Mailing Address - Country:US
Mailing Address - Phone:714-839-2300
Mailing Address - Fax:714-839-2320
Practice Address - Street 1:710 S HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-2337
Practice Address - Country:US
Practice Address - Phone:714-839-2300
Practice Address - Fax:714-839-2320
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC24491111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor