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General NPI Number Information
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NPI Number | 1477943546
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Entity Type | Organization
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Legal Business Name | GENE J. PAK DDS CORPORATION
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Dates
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Enumeration Date | 01/28/2015
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Last Update Date | 08/18/2016
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Provider Practice Location Address
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Address Line | 28562 OSO PKWY STE K
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-5599
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Country | US
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Telephone | 949-459-7212
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Fax |
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Provider Business Mailing Address
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Address Line | 28562 OSO PKWY STE K
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City | RANCHO SANTA MARGARITA
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State | CA
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Zip | 92688-5599
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Country | US
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Telephone | 949-459-7212
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GENE PAK
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Credential | DDS
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Telephone | 949-459-7212
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 27207
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 53909
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 57231
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 59385
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License Number State | CA
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