MEDICARE: PAIK DENTAL GROUP INC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1417694662
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIK DENTAL GROUP INC

Provider Business Mailing Address
First Line	:	6046 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-4402
Country	:	US
Telephone Number	:	323-726-3204
Fax Number	:

Provider Business Practice Location Address
First Line	:	6046 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-4402
Country	:	US
Telephone Number	:	323-726-3204
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	EUN JU PAIK
Credential	:
Telephone Number	:	323-627-8073

Provider Enumeration Date	:	05/18/2022
Last Update Date	:	05/18/2022

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Directions to “PAIK DENTAL GROUP INC ” Practice Location

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