Provider Demographics
NPI:1083626220
Name:PAK, DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:PAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2925
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98907-2925
Mailing Address - Country:US
Mailing Address - Phone:509-895-0402
Mailing Address - Fax:509-248-0733
Practice Address - Street 1:315 HOLTON AVE
Practice Address - Street 2:STE 102
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3254
Practice Address - Country:US
Practice Address - Phone:509-895-0402
Practice Address - Fax:509-248-0733
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000446792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8430340Medicaid
WA8430340Medicaid
WAI20389Medicare UPIN
WA8856570Medicare ID - Type Unspecified
WA8862469Medicare PIN