1992962344 NPI number — MMK HEALTH CARE, A PROFESSIONAL MEDICAL CORPORATION

Table of content: MISS DENISHA SMITH LMHC (NPI 1760835656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992962344 NPI number — MMK HEALTH CARE, A PROFESSIONAL MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MMK HEALTH CARE, A PROFESSIONAL MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992962344
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 45228
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90045-0221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-419-0049
Provider Business Mailing Address Fax Number:
310-337-9459

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6327 RIGGS PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90045-1239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-419-0049
Provider Business Practice Location Address Fax Number:
310-337-9459
Provider Enumeration Date:
05/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KOSHAK
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
818-419-0049

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  A36588 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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