Healthcare Provider Details

I. General information

NPI: 1104862143
Provider Name (Legal Business Name): MIN-UNG PAK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 12/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13100 STUDEBAKER RD
NORWALK CA
90650
US

IV. Provider business mailing address

PO BOX 7096
STOCKTON CA
95267
US

V. Phone/Fax

Practice location:
  • Phone: 562-868-3751
  • Fax: 562-929-3582
Mailing address:
  • Phone: 209-956-7725
  • Fax: 209-956-7733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA39967
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: