Healthcare Provider Details

I. General information

NPI: 1164813820
Provider Name (Legal Business Name): PAK MEDICAL GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2015
Last Update Date: 01/21/2022
Certification Date: 01/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5-4280 KUHIO HWY UNIT G210
PRINCEVILLE HI
96722-5451
US

IV. Provider business mailing address

1672 INDEPENDENCE DR STE 310
NEW BRAUNFELS TX
78132-3898
US

V. Phone/Fax

Practice location:
  • Phone: 210-902-9217
  • Fax:
Mailing address:
  • Phone: 830-730-5025
  • Fax: 830-730-4207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1597
License Number StateHI

VIII. Authorized Official

Name: DR. HO SUNG PAK
Title or Position: OWNER
Credential: D.O.
Phone: 210-902-9217