Organization
MEDIZEN MAGNOLIA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID T MAI M.D. (PRESIDENT)
(714) 968-8998
Entity
Organization
Contact information
Practice address
17305 BROOKHURST ST, FOUNTAIN VALLEY, CA 92708-3721
(714) 968-8998
(714) 968-8628
Mailing address
17305 BROOKHURST ST, FOUNTAIN VALLEY, CA 92708-3721
(714) 968-8998
(714) 968-8628
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
—
CA
2085N0904X
Nuclear Radiology Physician
—
CA
2085R0202X
Diagnostic Radiology Physician
Primary
—
CA
2085U0001X
Diagnostic Ultrasound Physician
—
CA
261QR0200X
Radiology Clinic/Center
—
CA
Other
Enumeration date
06/06/2016
Last updated
06/06/2016
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