Provider Demographics
NPI:1962703827
Name:NGUYEN, MAI THI (NA)
Entity type:Individual
Prefix:MRS
First Name:MAI
Middle Name:THI
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:NA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 6TH AVE
Mailing Address - Street 2:APARTMENT 1
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1386
Mailing Address - Country:US
Mailing Address - Phone:415-279-2364
Mailing Address - Fax:
Practice Address - Street 1:110 6TH AVE
Practice Address - Street 2:APARTMENT 1
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1386
Practice Address - Country:US
Practice Address - Phone:415-279-2364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00104781374U00000X
CA00372880376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA074-38-7824-AOtherMEDICARE CLAIM NUMBER