MEDICARE: ANDREW SANG PAEK D.D.S.

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	122300000X	Dentist	22DI02377100	NJ

General Provider Information

NPI Number	:	1942456793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREW SANG PAEK D.D.S.

Provider Business Mailing Address
First Line	:	75 MONTGOMERY ST FL 402
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-3726
Country	:	US
Telephone Number	:	201-332-0403
Fax Number	:	201-630-7769

Provider Business Practice Location Address
First Line	:	75 MONTGOMERY ST FL 402
Second Line	:
City	:	JERSEY CITY
State	:	NJ
Zip	:	07302-3726
Country	:	US
Telephone Number	:	201-332-0403
Fax Number	:

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

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	08/10/2023

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