Healthcare Provider Details

I. General information

NPI: 1619061157
Provider Name (Legal Business Name): DAVID MOK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 06/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 S BUENA VISTA ST SUITE 100
BURBANK CA
91508
US

IV. Provider business mailing address

3452 E FOOTHILL BLVD SUITE 130
PASADENA CA
91107-3142
US

V. Phone/Fax

Practice location:
  • Phone: 818-848-6404
  • Fax: 818-848-7112
Mailing address:
  • Phone: 626-793-2885
  • Fax: 626-793-6262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberG83222
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberG83222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: