Macknet, Kenneth Dale
Macknet, Kenneth Dale is an individual health care provider with primary practice located at 25815 Barton Rd Suite 101, Loma Linda CA 92354-3893. He recently has 4 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery, Allopathic & Osteopathic Physicians / Pediatric Dermatology, Allopathic & Osteopathic Physicians / Procedural Dermatology, Allopathic & Osteopathic Physicians / Dermatology. Allopathic & Osteopathic Physicians / Dermatology is his primary health care specialty. Macknet, Kenneth Dale can be contacted via phone (909) 796-0224.Contact Information
Primary practice address
25815 Barton Rd Suite 101
Loma Linda CA 92354-3893
Phone: (909) 796-0224
Fax: (909) 796-0225
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / MOHS-Micrographic Surgery | 207ND0101X | A63594 | California |
| Allopathic & Osteopathic Physicians / Pediatric Dermatology | 207NP0225X | A63594 | California |
| Allopathic & Osteopathic Physicians / Procedural Dermatology | 207NS0135X | A63594 | California |
| Allopathic & Osteopathic Physicians / Dermatology | 207N00000X | A63594 | California |
Profile Details
| NPI number | 1922199306 |
|---|---|
| LBN Legal business name | Macknet, Kenneth Dale |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 28th, 2006 |
| Last updated | Dec 24th, 2018 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1922199306 | NPPES |
| California | MEDICAID | OOA639542 | |
| California | Other | 756071339 |
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