Provider Demographics
NPI:1063640431
Name:PAIK, LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:
Last Name:PAIK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E STATE ST STE 205
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-3434
Mailing Address - Country:US
Mailing Address - Phone:610-565-2776
Mailing Address - Fax:610-565-4247
Practice Address - Street 1:200 E STATE ST STE 205
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3434
Practice Address - Country:US
Practice Address - Phone:610-565-2776
Practice Address - Fax:610-565-4247
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY272974208800000X
MI5101018093208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology