Provider Demographics
NPI:1174377295
Name:MAI, NGOC NICK THANH
Entity type:Individual
Prefix:
First Name:NGOC
Middle Name:NICK THANH
Last Name:MAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2152 S JETTY DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-4915
Mailing Address - Country:US
Mailing Address - Phone:714-699-9270
Mailing Address - Fax:
Practice Address - Street 1:2152 S JETTY DR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-4915
Practice Address - Country:US
Practice Address - Phone:714-699-9270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No171R00000XOther Service ProvidersInterpreter
No171WH0202XOther Service ProvidersContractorHome Modifications
No172A00000XOther Service ProvidersDriver
No1744G0900XOther Service ProvidersSpecialistGraphics Designer
No251E00000XAgenciesHome Health
No251G00000XAgenciesHospice Care, Community Based
No251T00000XAgenciesProgram of All-Inclusive Care for the Elderly (PACE) Provider Organization
No251V00000XAgenciesVoluntary or Charitable
No385H00000XRespite Care FacilityRespite Care