Provider Demographics
NPI:1740827369
Name:DMK LLC
Entity type:Organization
Organization Name:DMK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KALOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-309-3919
Mailing Address - Street 1:482 SAUNDERS DR
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-7678
Mailing Address - Country:US
Mailing Address - Phone:415-309-3919
Mailing Address - Fax:707-996-9965
Practice Address - Street 1:462 W NAPA ST
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6519
Practice Address - Country:US
Practice Address - Phone:707-800-2302
Practice Address - Fax:707-996-9965
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care