Healthcare Provider Details

I. General information

NPI: 1932341765
Provider Name (Legal Business Name): YOON PAK MD MEDICAL IMAGING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2009
Last Update Date: 03/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11843 SOUTH ST
CERRITOS CA
90703-6825
US

IV. Provider business mailing address

11843 SOUTH ST
CERRITOS CA
90703-6825
US

V. Phone/Fax

Practice location:
  • Phone: 562-809-8082
  • Fax: 562-809-3893
Mailing address:
  • Phone: 562-809-8082
  • Fax: 562-809-3893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA62072
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG77617
License Number StateCA

VIII. Authorized Official

Name: DR. YOON S PAK
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 562-809-8082