Healthcare Provider Details

I. General information

NPI: 1295830685
Provider Name (Legal Business Name): ANNA PAK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10243 GENETIC CENTER DR FL 2
SAN DIEGO CA
92121-6310
US

IV. Provider business mailing address

10243 GENETIC CENTER DR FL 2
SAN DIEGO CA
92121-6310
US

V. Phone/Fax

Practice location:
  • Phone: 858-499-2701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC199367
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: