Provider Demographics
NPI:1821286980
Name:MAK, CHUN KEUNG (DC, QME, EMT)
Entity Type:Individual
Prefix:DR
First Name:CHUN KEUNG
Middle Name:
Last Name:MAK
Suffix:
Gender:M
Credentials:DC, QME, EMT
Other - Prefix:
Other - First Name:ISRAEL
Other - Middle Name:
Other - Last Name:MAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:10141 WESTMINSTER AVE #204
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843
Mailing Address - Country:US
Mailing Address - Phone:562-895-1913
Mailing Address - Fax:714-590-2232
Practice Address - Street 1:10141 WESTMINSTER AVE #204
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843
Practice Address - Country:US
Practice Address - Phone:562-895-1913
Practice Address - Fax:714-590-2232
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30705111NI0013X
CAE074526146N00000X
WACH60345731111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic