Provider Demographics
NPI:1801208954
Name:MAK, GARY KWOKKING (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:KWOKKING
Last Name:MAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 CORONET LN
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-1940
Mailing Address - Country:US
Mailing Address - Phone:646-853-8289
Mailing Address - Fax:
Practice Address - Street 1:6325 SAUNDERS ST APT 3A
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-2009
Practice Address - Country:US
Practice Address - Phone:646-853-8289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-23
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY288968208000000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics