Provider Demographics
NPI:1902910904
Name:MAK, ALBERT C (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:C
Last Name:MAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 80520
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91118-8520
Mailing Address - Country:US
Mailing Address - Phone:626-227-2777
Mailing Address - Fax:626-227-2747
Practice Address - Street 1:707 S GARFIELD AVE STE B002
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-5866
Practice Address - Country:US
Practice Address - Phone:626-227-2777
Practice Address - Fax:626-227-2747
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79330174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G793300Medicaid
CAWG79330AMedicare PIN
CAW15436AMedicare PIN
CAW15436Medicare PIN
CAWG79330BMedicare PIN
CA00G793300Medicaid