Provider Demographics
NPI:1225083868
Name:MAK, HAILEN (MD)
Entity Type:Individual
Prefix:DR
First Name:HAILEN
Middle Name:
Last Name:MAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 OAKCREEK DR
Mailing Address - Street 2:#405
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-2033
Mailing Address - Country:US
Mailing Address - Phone:650-322-3847
Mailing Address - Fax:650-322-3249
Practice Address - Street 1:1101 WELCH RD
Practice Address - Street 2:SUITE A-2
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1924
Practice Address - Country:US
Practice Address - Phone:650-322-3847
Practice Address - Fax:650-322-3249
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29821207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G298210Medicare ID - Type Unspecified
A44179Medicare UPIN