Healthcare Provider Details

I. General information

NPI: 1699844456
Provider Name (Legal Business Name): PATRICK C E PAIK MD MED CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 09/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N GARFIELD AVENUE SUITE 312
MONTEREY PARK CA
91754-1171
US

IV. Provider business mailing address

600 N GARFIELD AVENUE SUITE 312
MONTEREY PARK CA
91754-1171
US

V. Phone/Fax

Practice location:
  • Phone: 626-280-0584
  • Fax: 626-280-3039
Mailing address:
  • Phone: 626-280-0584
  • Fax: 626-280-3039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA32957
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberA32957
License Number StateCA

VIII. Authorized Official

Name: PATRICK C E PAIK
Title or Position: PRESIDENT
Credential: MD
Phone: 626-280-0584