Provider Demographics
NPI:1922799576
Name:KOVAR, MARK DYLAN
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:DYLAN
Last Name:KOVAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16366 WHITEFIELD CT
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-6141
Mailing Address - Country:US
Mailing Address - Phone:817-688-7091
Mailing Address - Fax:
Practice Address - Street 1:16366 WHITEFIELD CT
Practice Address - Street 2:
Practice Address - City:CHINO HILLS
Practice Address - State:CA
Practice Address - Zip Code:91709-6141
Practice Address - Country:US
Practice Address - Phone:817-688-7091
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-16
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program