Provider Demographics
NPI:1326236381
Name:LINDA MAK MD INC.
Entity Type:Organization
Organization Name:LINDA MAK MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-333-1418
Mailing Address - Street 1:PO BOX 28190
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-8190
Mailing Address - Country:US
Mailing Address - Phone:559-448-8412
Mailing Address - Fax:559-448-8415
Practice Address - Street 1:1381 E HERNDON AVE STE 109
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3307
Practice Address - Country:US
Practice Address - Phone:558-448-8412
Practice Address - Fax:559-448-8415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51014207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ23331ZMedicare PIN