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General NPI Number Information
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NPI Number | 1750579348
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Entity Type | Organization
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Legal Business Name | LINDA MAK, MD, INC.
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Dates
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Enumeration Date | 10/09/2007
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Last Update Date | 10/09/2007
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Provider Practice Location Address
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Address Line | 74-900 HWY 111, STE 212
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City | INDIAN WELLS
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State | CA
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Zip | 92210
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Country | US
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Telephone | 760-568-0209
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Fax | 760-568-0184
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Provider Business Mailing Address
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Address Line | PO BOX 5819
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City | LA QUINTA
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State | CA
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Zip | 92248-5819
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Country | US
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Telephone | 760-568-0209
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Fax | 760-568-0184
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Authorized Official
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Title or Position | PRESIDENT, CEO
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Name | LINDA MAK
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Credential | M.D.
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Telephone | 760-333-1418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | A51014
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License Number State | CA
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