Organization
K. D. MACKNET, M.D., INC.
Active
Other names
Loma Linda Dermatology Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENNETH D MACKNET JR. M.D. (VICE PRESIDENT)
(909) 796-0224
Entity
Organization
Contact information
Practice address
25815 BARTON ROAD, SUITE 101, LOMA LINDA, CA 92354-3894
(909) 796-0224
(909) 796-0225
Mailing address
25815 BARTON ROAD, SUITE 101, LOMA LINDA, CA 92354-3894
(909) 796-0224
(909) 796-0225
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
261Q00000X
Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
05D0687031
CLIA
CA
01
—
1083791644
NPI
—
05
—
A63594
—
CA
Enumeration date
11/01/2006
Last updated
03/16/2017
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