=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427802461
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID PAIK INC PS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/16/2024
-----------------------------------------------------
Last Update Date | 04/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3425 NW 9TH AVE
-----------------------------------------------------
City | CAMAS
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98607-8151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-435-5044
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3425 NW 9TH AVE
-----------------------------------------------------
City | CAMAS
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98607-8151
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-435-5044
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER
-----------------------------------------------------
Name | DAVID PAIK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 360-514-7078
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------