Healthcare Provider Details

I. General information

NPI: 1841860293
Provider Name (Legal Business Name): CARRIE MOK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 W CALIFORNIA BLVD
PASADENA CA
91105-3010
US

IV. Provider business mailing address

10624 S EASTERN AVE STE A-955
HENDERSON NV
89052-2982
US

V. Phone/Fax

Practice location:
  • Phone: 626-352-1444
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA192602
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25595
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: