Healthcare Provider Details

I. General information

NPI: 1447653746
Provider Name (Legal Business Name): MAC, MAKSIM AND YANG DENTAL PARTNERSHIP A GENERAL PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2014
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8534 HOPSEED LN
SAN DIEGO CA
92129-4166
US

IV. Provider business mailing address

8534 HOPSEED LN
SAN DIEGO CA
92129-4166
US

V. Phone/Fax

Practice location:
  • Phone: 240-383-7623
  • Fax:
Mailing address:
  • Phone: 240-383-7623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number35429
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number41808
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number45585
License Number StateCA

VIII. Authorized Official

Name: FRANK XUONG MAC
Title or Position: DOCTOR
Credential:
Phone: 240-383-7623