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General NPI Number Information
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NPI Number | 1740827369
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Entity Type | Organization
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Legal Business Name | DMK LLC
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Dates
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Enumeration Date | 12/02/2019
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Last Update Date | 12/02/2019
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Provider Practice Location Address
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Address Line | 462 W NAPA ST
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City | SONOMA
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State | CA
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Zip | 95476-6519
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Country | US
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Telephone | 707-800-2302
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Fax | 707-996-9965
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Provider Business Mailing Address
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Address Line | 482 SAUNDERS DR
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City | SONOMA
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State | CA
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Zip | 95476-7678
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Country | US
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Telephone | 415-309-3919
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Fax | 707-996-9965
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Authorized Official
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Title or Position | FOUNDER AND CEO
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Name | MS. DENISE M KALOS
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Credential |
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Telephone | 415-309-3919
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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