Provider Demographics
NPI:1518306844
Name:MAK, PAK HEI (MS, RD)
Entity Type:Individual
Prefix:
First Name:PAK HEI
Middle Name:
Last Name:MAK
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1854 CITRUS VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91010-3215
Mailing Address - Country:US
Mailing Address - Phone:626-759-4676
Mailing Address - Fax:
Practice Address - Street 1:1854 CITRUS VIEW AVE
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-3215
Practice Address - Country:US
Practice Address - Phone:626-759-4676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-19
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1055901133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered