MEDICARE: DR. WONKYU PAK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	G59023	CA

General Provider Information

NPI Number	:	1376542894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WONKYU PAK M.D.

Provider Business Mailing Address
First Line	:	266 S HARVARD BLVD STE 500
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-4390
Country	:	US
Telephone Number	:	310-433-8156
Fax Number	:

Provider Business Practice Location Address
First Line	:	266 S HARVARD BLVD
Second Line	:	SUITE 500
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-4372
Country	:	US
Telephone Number	:	213-739-6900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	06/28/2022

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