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General NPI Number Information
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NPI Number | 1588955694
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Entity Type | Individual
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Provider Name | PETER SUNGJIN PAK M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/22/2011
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Last Update Date | 07/19/2024
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Provider Practice Location Address
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Address Line | 27799 MEDICAL CENTER RD STE 440
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City | MISSION VIEJO
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State | CA
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Zip | 92691-6400
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Country | US
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Telephone | 949-364-1007
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Fax | 949-264-0317
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Provider Business Mailing Address
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Address Line | 9550 JELLICO AVE
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City | NORTHRIDGE
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State | CA
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Zip | 91325-2029
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Country | US
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Telephone | 818-489-0249
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Fax |
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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 | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | A139698
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | D86651
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License Number State | MD
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