Lisa Chung Yun Mak, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

34840 Issued in CA

Practice address

251 W Bencamp St
San Gabriel, CA 91776-3798

Phone

(626) 282-2567

NPI assigned

Aug 5, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Dr. Lisa Chung Yun Chan Former name

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• First Optometric Care of Northern California PC

  • Optometrist
  • Rancho Cordova, CA
  • NPI 1154972404

  CA, Optometrist

  Medicare reassignment NPD
• Third Optometric Care of California

  • Optometrist
  • Rancho Cordova, CA
  • NPI 1013516103

  CA, Optometrist

  Medicare reassignment NPD
• Total Vision PC

  • Optometrist
  • San Diego, CA
  • NPI 1356813711

  CA, Optometrist

  Medicare reassignment NPD
• First Optometric Care of Northern California PC

  • Optometrist
  • Sacramento, CA
  • NPI 1457946931
  NPD
• First Optometric Care of Northern California PC

  • Optometrist
  • San Jose, CA
  • NPI 1487537452
  NPD
• Third Optometric Care of California PC

  • Optometrist
  • Palmdale, CA
  • NPI 1215824768
  NPD
• First Optometric Care of Northern California PC

  • Optometrist
  • Norwalk, CA
  • NPI 1316532898
  NPD (past)
• Mark a. Chung, O.D., a Professional Corporation

  • Optometrist
  • West Hollywood, CA
  • NPI 1861800997
  NPD (past)
• Third Optometric Care of California PC

  • Optometrist
  • Irvine, CA
  • NPI 1164017554
  NPD (past)
• Third Optometric Care of California PC

  • Optometrist
  • Irvine, CA
  • NPI 1609461003
  NPD (past)

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

{
    "created_epoch": "1628121600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640131200000",
    "number": "1649944331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 FIXIE",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926181033",
            "telephone_number": "949-290-2739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "251 W BENCAMP ST",
            "city": "SAN GABRIEL",
            "state": "CA",
            "postal_code": "917763798",
            "telephone_number": "626-282-2567"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6440 E Pacific Coast Hwy Spc B-165",
            "address_purpose": "LOCATION",
            "city": "Long Beach",
            "state": "CA",
            "postal_code": "908034268",
            "country_code": "US",
            "telephone_number": "562-280-2148",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MAK",
        "first_name": "LISA",
        "middle_name": "CHUNG YUN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-08-05",
        "last_updated": "2021-12-22",
        "certification_date": "2021-12-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "34840",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LISA",
            "last_name": "CHAN",
            "middle_name": "CHUNG YUN",
            "prefix": "DR.",
            "credential": "OD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Dawei Lyu
• Michael Ma, MD
• Su-Chen Ma, L. AC.
• Anuradha Venugopal Madhavan, PT
• Lavie Mai
• Pattie CHI Choy Mak, WH N.P.-BC
• Leslie Maldonado Jimenez
• Maluk Enterprising Corporation
• Maluk Enterprising Corporation
• Marian Family Clinic a Professional Corporation

• All providers in San Gabriel, CA
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.