Provider Demographics
NPI:1316937931
Name:KAL, MARK (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:KAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1100
Mailing Address - Street 2:
Mailing Address - City:GUALALA
Mailing Address - State:CA
Mailing Address - Zip Code:95445-1100
Mailing Address - Country:US
Mailing Address - Phone:707-884-4005
Mailing Address - Fax:707-884-9728
Practice Address - Street 1:46900 OCEAN DR
Practice Address - Street 2:
Practice Address - City:GUALALA
Practice Address - State:CA
Practice Address - Zip Code:95445-8353
Practice Address - Country:US
Practice Address - Phone:707-884-4005
Practice Address - Fax:707-884-9728
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2014-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG56821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP01070319OtherRAILROAD MEDICARE
CAP01070319OtherRAILROAD MEDICARE
CABM922YMedicare PIN