Provider Demographics
NPI:1083782353
Name:PAIK, MISUNG (DDS)
Entity Type:Individual
Prefix:MRS
First Name:MISUNG
Middle Name:
Last Name:PAIK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1816 LOMITA BLVD
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-1906
Mailing Address - Country:US
Mailing Address - Phone:310-326-4117
Mailing Address - Fax:310-326-0081
Practice Address - Street 1:1816 LOMITA BLVD
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-1906
Practice Address - Country:US
Practice Address - Phone:310-326-4117
Practice Address - Fax:310-326-0081
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45948122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB45948OtherDENTI-CAL PROVIDER