Healthcare Provider Details

I. General information

NPI: 1821286980
Provider Name (Legal Business Name): CHUN KEUNG MAK D.C., Q.M.E., E.M.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ISRAEL MAK

II. Dates (important events)

Enumeration Date: 10/12/2007
Last Update Date: 05/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10141 WESTMINSTER AVE #204
GARDEN GROVE CA
92843
US

IV. Provider business mailing address

10141 WESTMINSTER AVE #204
GARDEN GROVE CA
92843
US

V. Phone/Fax

Practice location:
  • Phone: 562-895-1913
  • Fax: 714-590-2232
Mailing address:
  • Phone: 562-895-1913
  • Fax: 714-590-2232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberDC30705
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberE074526
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code111NI0013X
TaxonomyIndependent Medical Examiner Chiropractor
License NumberCH60345731
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: