Healthcare Provider Details

I. General information

NPI: 1386335842
Provider Name (Legal Business Name): KELVIN MAK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2023
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 RICHARD PERSON DR.
MARKHAM ON
L6C 1B1
CA

IV. Provider business mailing address

54 RICHARD PERSON DR.
MARKHAM ON
L6C 1B1
CA

V. Phone/Fax

Practice location:
  • Phone: 416-303-0080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA67298
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: