Provider Demographics
NPI:1992887293
Name:MAI, VINH (DO)
Entity type:Individual
Prefix:DR
First Name:VINH
Middle Name:
Last Name:MAI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:5410 MARYLAND WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5064
Mailing Address - Country:US
Mailing Address - Phone:615-377-5652
Mailing Address - Fax:888-241-1404
Practice Address - Street 1:2101 N WATERMAN AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4836
Practice Address - Country:US
Practice Address - Phone:909-881-4520
Practice Address - Fax:909-881-4526
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A9129174400000X, 208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA020A91290OtherBLUE SHIELD OF CALIFORNIA
CABM9216397OtherDEA NUMBER
CAAV815ZMedicare PIN