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General NPI Number Information
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NPI Number | 1023317922
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Entity Type | Individual
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Provider Name | HENRY KA FUNG MAK M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/18/2011
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Last Update Date | 03/18/2011
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Provider Practice Location Address
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Address Line | 1215 LEE ST BOX 800170
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22908-0816
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Country | US
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Telephone | 434-924-9484
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Fax | 434-924-9515
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Provider Business Mailing Address
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Address Line | 1215 LEE ST PO BOX 800170
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22908-0816
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Country | US
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Telephone | 434-924-9484
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Fax | 434-924-9515
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | 0116023202
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License Number State | VA
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