Provider Demographics
NPI:1649944331
Name:MAK, LISA CHUNG YUN (OD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:CHUNG YUN
Last Name:MAK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:CHUNG YUN
Other - Last Name:CHAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:124 FIXIE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-1033
Mailing Address - Country:US
Mailing Address - Phone:949-290-2739
Mailing Address - Fax:
Practice Address - Street 1:251 W BENCAMP ST
Practice Address - Street 2:
Practice Address - City:SAN GABRIEL
Practice Address - State:CA
Practice Address - Zip Code:91776-3798
Practice Address - Country:US
Practice Address - Phone:626-282-2567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-05
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34840152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist