MEDICARE: DR. JASON S. PAEK 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	207R00000X	Internal Medicine Physician	G58208	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
2	912171732	OTHER	CA	BLUE CROSS
3	00G582080	OTHER		BLUE SHIELD
4	0004332734	OTHER		AETNA
5	912171732A	OTHER	CA	HEALTH NET
6	TRICARE	OTHER	CA	912171732 91789 A001

General Provider Information

NPI Number	:	1770679631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON S. PAEK M.D.

Provider Business Mailing Address
First Line	:	18773 COLIMA RD
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-2949
Country	:	US
Telephone Number	:	626-986-4899
Fax Number	:	626-986-4855

Provider Business Practice Location Address
First Line	:	18773 COLIMA RD
Second Line	:
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-2949
Country	:	US
Telephone Number	:	626-986-4899
Fax Number	:	626-986-4855

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

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	01/09/2019

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