Individual provider Active NPI

Robert Hon Kwong Mak, MD

  • Pediatric Nephrology Physician
  • San Diego, CA
National Provider Identifier
1740295252
Registry record updated Oct 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nephrology PhysicianTaxonomy code 2080P0210X
License
A43991 Issued in CA
Practice address
8001 Frost St
Entrance 10
San Diego, CA 92123-2746
Phone
(858) 966-8052
NPI assigned
Jul 31, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nephrology Physician 2080P0210X A43991 CA Primary

Addresses

Primary practice location

8001 Frost St
Entrance 10
San Diego, CA 92123-2746

Mailing address

3860 Calle Fortunada
Ste #210
San Diego, CA 92123-4802
Phone (858) 309-6303

Other identifiers 1

IdentifierTypeStateIssuer
00A439910MedicaidCA

Medicare participation

Medicare enrollment files
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: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070710000879 CA Practitioner - NephrologyPractitioner - Pediatric MedicinePractitioner - Other (Physician) 1951204981 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A43991CAMDPediatric Nephrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children'S Specialists of San Diego - Div of Hem&Onc Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1154304000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1318550400000",
    "number": "1740295252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3860 CALLE FORTUNADA",
            "address_2": "STE #210",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921234802",
            "telephone_number": "858-309-6303",
            "fax_number": "858-309-6301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8001 FROST ST",
            "address_2": "ENTRANCE 10",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921232746",
            "telephone_number": "858-966-8052"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAK",
        "first_name": "ROBERT",
        "middle_name": "HON KWONG",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-31",
        "last_updated": "2011-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080P0210X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Pediatric Nephrology",
            "state": "CA",
            "license": "A43991",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A439910",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

Verify at the official NPI Registry.