Su Mei Mai

Primary specialty

DentistTaxonomy code 122300000X

License

101839 Issued in CA

Practice address

3745 Fredricksburg St Apt B
Fort Irwin, CA 92310-1701

Phone

(270) 798-8751

NPI assigned

Aug 8, 2017

Last updated

Mar 18, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Kwon DDS Professional Corporation

  dba Mead Valley Community Dental Clinic

  • Dentist
  • Perris, CA
  • NPI 1881021434
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1502150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616025600000",
    "number": "1487179743",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3745 FREDRICKSBURG ST APT B",
            "city": "FORT IRWIN",
            "state": "CA",
            "postal_code": "923101701",
            "telephone_number": "270-798-8751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3745 FREDRICKSBURG ST APT B",
            "city": "FORT IRWIN",
            "state": "CA",
            "postal_code": "923101701",
            "telephone_number": "270-798-8751"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAI",
        "first_name": "SU MEI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-08-08",
        "last_updated": "2021-03-18",
        "certification_date": "2021-03-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "101839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Richard Lopez
• Dolores Luque, DMD
• Huy Quoc Luu, MD
• Amy Lyyski, MPT
• Melissa Jane Maddox, RDH
• Karrie Maloney
• Patrice Luzelle Ermita Mara, DMD
• Maryann Margheim
• Gregory Robert Marshall Jr., LPN
• Ismael Martinezcruz, DENTAL ASSISTANT

• Dentist in Fort Irwin, CA
• Providers in Fort Irwin, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.