Healthcare Provider Details

I. General information

NPI: 1336305267
Provider Name (Legal Business Name): ABC PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3663 W 6TH ST STE 301
LOS ANGELES CA
90020-3050
US

IV. Provider business mailing address

3663 W 6TH ST STE 301
LOS ANGELES CA
90020-3050
US

V. Phone/Fax

Practice location:
  • Phone: 213-291-3228
  • Fax: 213-596-8848
Mailing address:
  • Phone: 213-291-3228
  • Fax: 213-596-8848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA95866
License Number StateCA

VIII. Authorized Official

Name: DR. WOO H PAEK
Title or Position: DIRECTOR
Credential: M.D.
Phone: 213-291-3228