Provider Demographics
NPI:1043653876
Name:PAK, JINKYUNG (PA)
Entity Type:Individual
Prefix:
First Name:JINKYUNG
Middle Name:
Last Name:PAK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3005 GROSS AVE
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-6493
Mailing Address - Country:US
Mailing Address - Phone:919-426-8031
Mailing Address - Fax:
Practice Address - Street 1:141 PARK AT NORTH HILLS ST
Practice Address - Street 2:STE #116
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27609-5989
Practice Address - Country:US
Practice Address - Phone:800-234-3325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC001003992363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant