MEDICARE: KEVIN I PAK MD

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	208100000X	Physical Medicine & Rehabilitation Physician	MT184507	PA
2	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	247616-B18	NY

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	:	1508922527
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEVIN I PAK MD

Provider Business Mailing Address
First Line	:	7206 NORTHERN BLVD
Second Line	:	2ND FLOOR
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1049
Country	:	US
Telephone Number	:	866-670-6824
Fax Number	:	178-533-1774

Provider Business Practice Location Address
First Line	:	7206 NORTHERN BLVD
Second Line	:	2ND FLOOR
City	:	JACKSON HEIGHTS
State	:	NY
Zip	:	11372-1049
Country	:	US
Telephone Number	:	866-670-6824
Fax Number	:	178-533-1774

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

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	10/09/2025

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