Healthcare Provider Details

I. General information

NPI: 1972638229
Provider Name (Legal Business Name): HANG PAK D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2007
Last Update Date: 01/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S ORANGE AVE SUITE 201
LIVINGSTON NJ
07039-5817
US

IV. Provider business mailing address

3100 SPRING FOREST RD STE 130
RALEIGH NC
27616-2880
US

V. Phone/Fax

Practice location:
  • Phone: 973-322-7246
  • Fax: 973-322-7791
Mailing address:
  • Phone: 919-882-0706
  • Fax: 919-873-9821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMB05559400
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMB05559400
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMB05559400
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMB05559400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: