Provider Demographics
NPI:1275787210
Name:MAK AND KLEIGER, D.D.S.
Entity Type:Organization
Organization Name:MAK AND KLEIGER, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:B
Authorized Official - Last Name:MAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-793-6175
Mailing Address - Street 1:959 E WALNUT ST STE 216
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-5362
Mailing Address - Country:US
Mailing Address - Phone:626-793-6175
Mailing Address - Fax:626-793-9317
Practice Address - Street 1:959 E WALNUT ST STE 216
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-5362
Practice Address - Country:US
Practice Address - Phone:626-793-6175
Practice Address - Fax:626-793-9317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA114401911223G0001X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty