=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649271362
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WESLEY KWUNGSUH PAK D.C.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/03/2005
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1807 SANTA RITA RD SUITE D
-----------------------------------------------------
City | PLEASANTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94566-4779
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-846-2225
-----------------------------------------------------
Fax | 925-846-2230
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2224 GROUSE WAY
-----------------------------------------------------
City | UNION CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94587-4613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-429-7651
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC27836
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------