MEDICARE: DR. WOONG KI PAIK 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	207R00000X	Internal Medicine Physician	250227	NY
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	250227	NY

General Provider Information

NPI Number	:	1700034378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WOONG KI PAIK M.D.

Provider Business Mailing Address
First Line	:	4500 PARSONS BLVD
Second Line	:	FHMC AMBULATORY CARE CLINIC
City	:	FLUSHING
State	:	NY
Zip	:	11355-2205
Country	:	US
Telephone Number	:	718-670-5488
Fax Number	:	718-670-8988

Provider Business Practice Location Address
First Line	:	45- 00 PARSONS BLV
Second Line	:	FHMC AMBULATORY CARE CLINIC
City	:	FLUSHING
State	:	NY
Zip	:	11355-0000
Country	:	US
Telephone Number	:	718-670-5488
Fax Number	:	718-670-8988

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

Provider Enumeration Date	:	09/08/2008
Last Update Date	:	08/24/2009

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