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NPI Code Detail

MEDICARE: DR. CHIN HO PAK M.D.

MEDICARE: DR. CHIN HO PAK M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry Physician200300514NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386721470
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHIN HO PAK M.D.
Provider Business Mailing Address
First Line : 284 EXECUTIVE PARK DR
Second Line : SUITE 100
City : CONCORD
State : NC
Zip : 28025-1833
Country : US
Telephone Number : 704-939-1100
Fax Number : 704-939-1173
Provider Business Practice Location Address
First Line : 1190 W ROOSEVELT BLVD
Second Line :
City : MONROE
State : NC
Zip : 28110-2818
Country : US
Telephone Number : 704-296-6200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 11/27/2023

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