Provider Demographics
NPI:1477738276
Name:MAK, CHUN K (DDS PHD)
Entity Type:Individual
Prefix:
First Name:CHUN
Middle Name:K
Last Name:MAK
Suffix:
Gender:M
Credentials:DDS PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121
Mailing Address - Country:US
Mailing Address - Phone:415-387-0614
Mailing Address - Fax:415-387-0615
Practice Address - Street 1:296 21ST AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121
Practice Address - Country:US
Practice Address - Phone:415-387-0614
Practice Address - Fax:415-387-0615
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53829122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist