Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NI0013X | Independent Medical Examiner | CH60345731 | WA |
Y | 111NI0013X | Independent Medical Examiner | DC30705 | CA |
NPI | 1821286980 |
---|---|
Provider Name | Dr. Chun Keung Mak |
First Address | Garden Grove, CA 92843 |
Second Address | Garden Grove, CA 92843 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/10/2007 |
Last Update Date | 24/05/2013 |