K. D. Macknet, M.D., INC.
Dermatology in Loma Linda, CA. Organization (NPI-2).
NPI number1083791644
StatusActive
Last updated in NPPESMar 16, 2017
Details
- NPI
- 1083791644
- Entity type
- Organization (NPI-2)
- Legal business name
- K. D. Macknet, M.D., INC.
- Organization subpart
- No
- Enumeration date
- Nov 1, 2006
- Last updated
- Mar 16, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207N00000X | Dermatology | – | – | Yes |
| 261Q00000X | Clinic/Center | – | – |
Other names
- Loma Linda Dermatology Medical Group (Doing Business As)
Practice location
25815 Barton RoadSuite 101
Loma Linda, CA 92354-3894
Phone 909-796-0224 · Fax 909-796-0225
Mailing address
25815 Barton RoadSuite 101
Loma Linda, CA 92354-3894
Phone 909-796-0224 · Fax 909-796-0225
Authorized official
Kenneth D Macknet
Vice President
9097960224
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