Provider Demographics
NPI:1205008430
Name:PAIK, RYAN KAWIKA (DPT)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:KAWIKA
Last Name:PAIK
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6102 AVENIDA ENCINAS
Mailing Address - Street 2:STE E
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92011-1005
Mailing Address - Country:US
Mailing Address - Phone:760-692-5142
Mailing Address - Fax:760-692-5142
Practice Address - Street 1:700 GARDEN VIEW CT
Practice Address - Street 2:SUITE 103
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2478
Practice Address - Country:US
Practice Address - Phone:760-632-6942
Practice Address - Fax:760-632-6670
Is Sole Proprietor?:No
Enumeration Date:2008-03-27
Last Update Date:2016-05-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA34256225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10480AMedicare UPIN