MEDICARE: RICHARD PAK DDS

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	1223E0200X	Endodontics	60077	CA

General Provider Information

NPI Number	:	1861631228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD PAK DDS

Provider Business Mailing Address
First Line	:	600 W BEVERLY BLVD STE B
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-3660
Country	:	US
Telephone Number	:	310-804-5479
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 W BEVERLY BLVD STE B
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-3660
Country	:	US
Telephone Number	:	310-804-5479
Fax Number	:

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

Provider Enumeration Date	:	02/09/2009
Last Update Date	:	04/30/2024

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