Provider Demographics
NPI:1710142492
Name:MAK, MARIAN KIM (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:KIM
Last Name:MAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARIAN
Other - Middle Name:SOOJIN
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:710 LAWRENCE EXPY
Mailing Address - Street 2:DEPARTMENT 190
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-5173
Mailing Address - Country:US
Mailing Address - Phone:408-554-9810
Mailing Address - Fax:
Practice Address - Street 1:710 LAWRENCE EXPY
Practice Address - Street 2:DEPARTMENT 190
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-5173
Practice Address - Country:US
Practice Address - Phone:408-554-9810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-22
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA116278208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics