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NPI Code Detail

MEDICARE: PAK PODIATRY CORP.

MEDICARE: PAK PODIATRY CORP.
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
1261QP1100XPodiatric Clinic/CenterE4251CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1E4251OTHERCACALIFRONIA LICENSE NUMBER

General Provider Information

NPI Number : 1396796306
Entity Type Code : Organization
Provider Name (Legal Business Name) : PAK PODIATRY CORP.
Provider Business Mailing Address
First Line : 1711 W TEMPLE ST
Second Line : SUITE #3600
City : LOS ANGELES
State : CA
Zip : 90026-5421
Country : US
Telephone Number : 213-989-0700
Fax Number : 213-989-0703
Provider Business Practice Location Address
First Line : 1711 W TEMPLE ST
Second Line : SUITE #3600
City : LOS ANGELES
State : CA
Zip : 90026-5421
Country : US
Telephone Number : 213-989-0700
Fax Number : 213-989-0703
Authorized Official
Title or Position : OWNER/PRESIDENT
Name : DR. SANG JOON PAK
Credential : D.P.M
Telephone Number : 213-989-0700
Provider Enumeration Date : 05/14/2006
Last Update Date : 01/24/2009

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Directions to “PAK PODIATRY CORP. ” Practice Location

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