Provider Demographics
NPI:1881216208
Name:MKP INTERNAL MEDICINE
Entity Type:Organization
Organization Name:MKP INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONIQUE
Authorized Official - Middle Name:K
Authorized Official - Last Name:PHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:657-390-6840
Mailing Address - Street 1:1 LEAGUE UNIT 60924
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602-7040
Mailing Address - Country:US
Mailing Address - Phone:657-390-6840
Mailing Address - Fax:
Practice Address - Street 1:59 DECKER
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-7348
Practice Address - Country:US
Practice Address - Phone:657-390-6840
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty