Active NPI
Phong Mai
- Pharmacist
- San Pedro, CA
National Provider Identifier
1063943553
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 66391
- Practice address
- 700 S Gaffey St
San Pedro, CA 90731-3029 - Phone
- (310) 514-2003
- Fax
- (310) 514-2136
- NPI assigned
- Mar 25, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 66391 | CA | Primary |
Addresses
Primary practice location
700 S Gaffey St
San Pedro, CA 90731-3029
Mailing address
700 S Gaffey St
San Pedro, CA 90731-3029
Phone (310) 514-2003
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 66391 | CA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1490400000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1490400000000",
"number": "1063943553",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 S GAFFEY ST",
"city": "SAN PEDRO",
"state": "CA",
"postal_code": "907313029",
"telephone_number": "310-514-2003",
"fax_number": "310-514-2136"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 S GAFFEY ST",
"city": "SAN PEDRO",
"state": "CA",
"postal_code": "907313029",
"telephone_number": "310-514-2003",
"fax_number": "310-514-2136"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MAI",
"first_name": "PHONG",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-03-25",
"last_updated": "2017-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "CA",
"license": "66391",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Pedro, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.