Healthcare Provider Details

I. General information

NPI: 1306588686
Provider Name (Legal Business Name): THOMAS KUN PAK MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2022
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 WESTWOOD PLZ STE 37-384
LOS ANGELES CA
90024-5055
US

IV. Provider business mailing address

5900 BALCONES DR # 24070
AUSTIN TX
78731-4257
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-6721
  • Fax:
Mailing address:
  • Phone: 310-206-6721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberV2542
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA209825
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: