Healthcare Provider Details

I. General information

NPI: 1275787210
Provider Name (Legal Business Name): MAK AND KLEIGER, D.D.S.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

959 E WALNUT ST STE 216
PASADENA CA
91106-5362
US

IV. Provider business mailing address

959 E WALNUT ST STE 216
PASADENA CA
91106-5362
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-6175
  • Fax: 626-793-9317
Mailing address:
  • Phone: 626-793-6175
  • Fax: 626-793-9317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11440191
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number11440191
License Number StateCA

VIII. Authorized Official

Name: DR. KENNETH B MAK
Title or Position: OWNER/DENTIST
Credential: D.D.S.
Phone: 626-793-6175