MEDICARE: CHUN HONG PAK D.C.

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	111N00000X	Chiropractor	21461	CA

General Provider Information

NPI Number	:	1467660654
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHUN HONG PAK D.C.

Provider Business Mailing Address
First Line	:	4713 LANKERSHIM BLVD
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-1803
Country	:	US
Telephone Number	:	818-505-8228
Fax Number	:

Provider Business Practice Location Address
First Line	:	4713 LANKERSHIM BLVD
Second Line	:
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91602-1803
Country	:	US
Telephone Number	:	818-505-8228
Fax Number	:

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

Provider Enumeration Date	:	05/19/2007
Last Update Date	:	07/08/2007

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