NPIMap

Organization Active NPI

K. D. Macknet, M.D., Inc.

Doing business as Loma Linda Dermatology Medical Group

  • Dermatology Physician
  • Loma Linda, CA
National Provider Identifier
1083791644
Registry record updated Mar 16, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
K. D. MACKNET, M.D., INC.
Doing business as
Loma Linda Dermatology Medical Group
Practice address
25815 Barton Road
Suite 101
Loma Linda, CA 92354-3894
Phone
(909) 796-0224
Fax
(909) 796-0225
NPI assigned
Nov 1, 2006
Last updated
Mar 16, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 16, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Kenneth D Macknet Jr., M.D.
Title
Vice President
Phone
(909) 796-0224

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU
Dermatology Physician 207N00000X NU Primary

Addresses

Primary practice location

25815 Barton Road
Suite 101
Loma Linda, CA 92354-3894

Mailing address

25815 Barton Road
Suite 101
Loma Linda, CA 92354-3894
Phone (909) 796-0224

Other identifiers 3

IdentifierTypeStateIssuer
1083791644OtherNPI
A63594MedicaidCA
05D0687031OtherCACLIA

Other names 1

  • Loma Linda Dermatology Medical Group Doing business as

National Provider Directory

National Provider Directory

Locations

1620 E Second St
Ste N
Beaumont, CA 92223
Phone (951) 845-6500

25815 Barton Rd
Ste C101
Loma Linda, CA 92354
Phone (909) 796-0224

Practitioners & affiliated clinicians

Practitioners 19

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 19

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489622400000",
    "number": "1083791644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25815 BARTON ROAD",
            "address_2": "SUITE 101",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543894",
            "telephone_number": "909-796-0224",
            "fax_number": "909-796-0225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25815 BARTON ROAD",
            "address_2": "SUITE 101",
            "city": "LOMA LINDA",
            "state": "CA",
            "postal_code": "923543894",
            "telephone_number": "909-796-0224",
            "fax_number": "909-796-0225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "K. D. MACKNET, M.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2017-03-16",
        "status": "A",
        "authorized_official_last_name": "MACKNET",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "909-796-0224",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1083791644",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "A63594",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA",
            "identifier": "05D0687031",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Loma Linda Dermatology Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Loma Linda, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.