Provider Demographics
NPI:1174662233
Name:MAK, JIMMY (LAC PHD)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:
Last Name:MAK
Suffix:
Gender:M
Credentials:LAC PHD
Other - Prefix:
Other - First Name:JIMIN
Other - Middle Name:
Other - Last Name:MAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1777 BELLFLOWER BLVD
Mailing Address - Street 2:# 114
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815
Mailing Address - Country:US
Mailing Address - Phone:562-986-7922
Mailing Address - Fax:562-494-8993
Practice Address - Street 1:1777 BELLFLOWER BLVD
Practice Address - Street 2:# 114
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815
Practice Address - Country:US
Practice Address - Phone:562-986-7922
Practice Address - Fax:562-494-8993
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 4144171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0041440OtherMEDICAL