Individual
KENNETH W MAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1541 FLORIDA AVE, 301, MODESTO, CA 95350-4429
(209) 577-3388
(209) 523-0764
Mailing address
1541 FLORIDA AVE, 200, MODESTO, CA 95350-4429
(209) 577-3388
(209) 523-0764
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
A55527
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A555270
—
CA
01
—
CD069A
GROUP MEDICARE PTAN
CA
Enumeration date
05/06/2006
Last updated
12/21/2021
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