Provider Demographics
NPI:1417968009
Name:KITA, MARK STEVEN (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:KITA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2577 SAMARITAN DR STE 765
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-4109
Mailing Address - Country:US
Mailing Address - Phone:408-358-6163
Mailing Address - Fax:408-358-2302
Practice Address - Street 1:2577 SAMARITAN DR STE 765
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4109
Practice Address - Country:US
Practice Address - Phone:408-358-6163
Practice Address - Fax:408-358-2302
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG062424207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E47050Medicare UPIN
00G624240Medicare ID - Type Unspecified