Organization
K. D. MACKNET, M.D., INC.
Active
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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