Healthcare Provider Details

I. General information

NPI: 1619230596
Provider Name (Legal Business Name): MR. CHENEY MAK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2012
Last Update Date: 06/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N MAIN ST SUITE 201
SANTA ANA CA
92701-3640
US

IV. Provider business mailing address

1200 N MAIN ST SUITE 201
SANTA ANA CA
92701-3640
US

V. Phone/Fax

Practice location:
  • Phone: 714-480-6778
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: