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General NPI Number Information
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NPI Number | 1508922527
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Entity Type | Individual
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Provider Name | KEVIN I PAK MD
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Gender | Male
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Dates
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Enumeration Date | 12/28/2006
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 7206 NORTHERN BLVD 2ND FLOOR
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-1049
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Country | US
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Telephone | 866-670-6824
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Fax | 178-533-1774
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Provider Business Mailing Address
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Address Line | 7206 NORTHERN BLVD 2ND FLOOR
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-1049
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Country | US
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Telephone | 866-670-6824
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Fax | 178-533-1774
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | MT184507
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 2081S0010X
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Taxonomy Name | Sports Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 247616-B18
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License Number State | NY
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