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General NPI Number Information
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NPI Number | 1700946431
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Entity Type | Organization
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Legal Business Name | WANDA PAK, M.D., P.C.
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Dates
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Enumeration Date | 12/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3301 NEW MEXICO AVE., NW SUITE 226
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City | WASHINGTON
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State | DC
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Zip | 20016-3600
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Country | US
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Telephone | 202-244-9404
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Fax | 202-244-9403
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Provider Business Mailing Address
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Address Line | 3301 NEW MEXICO AVE., NW SUITE 226
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City | WASHINGTON
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State | DC
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Zip | 20016-3600
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Country | US
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Telephone | 202-244-9404
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Fax | 202-244-9403
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WANDA PAK
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Credential | M.D.
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Telephone | 202-244-9404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | M32178
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License Number State | DC
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