Healthcare Provider Details

I. General information

NPI: 1114338860
Provider Name (Legal Business Name): TERRIE PAK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2014
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27700 NORTHWEST FWY STE 440
CYPRESS TX
77433-6767
US

IV. Provider business mailing address

27700 NORTHWEST FWY STE 440
CYPRESS TX
77433-6767
US

V. Phone/Fax

Practice location:
  • Phone: 832-334-4011
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR3395
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: