MEDICARE: DR. EUGENE 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
1	2084N0400X	Neurology Physician	MD426970	PA
2	2084N0400X	Neurology Physician	239973	NY
3	2084N0400X	Neurology Physician	C138763	CA
4	2084P2900X	Pain Medicine (Psychiatry & Neurology) Physician	AM0443173-6259	NH
5	2084P2900X	Pain Medicine (Psychiatry & Neurology) Physician	C138763	CA

Other Identifiers

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

General Provider Information

NPI Number	:	1407891658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EUGENE PAK M.D.

Provider Business Mailing Address
First Line	:	11406 LOMA LINDA DRIVE
Second Line	:	SUITE 516
City	:	LOMA LINDA
State	:	CA
Zip	:	92354
Country	:	US
Telephone Number	:	909-558-6204
Fax Number	:

Provider Business Practice Location Address
First Line	:	11406 LOMA LINDA DR STE 516
Second Line	:
City	:	LOMA LINDA
State	:	CA
Zip	:	92354-3711
Country	:	US
Telephone Number	:	909-558-6204
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	07/21/2022

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