Provider Demographics
NPI:1225452907
Name:PAEK, JOHN (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:PAEK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:800 8TH AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-2602
Mailing Address - Country:US
Mailing Address - Phone:682-224-3748
Mailing Address - Fax:682-841-0039
Practice Address - Street 1:22999 HIGHWAY 59 N STE B220
Practice Address - Street 2:WEST TOWER
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-4460
Practice Address - Country:US
Practice Address - Phone:682-224-3748
Practice Address - Fax:682-841-0039
Is Sole Proprietor?:No
Enumeration Date:2014-02-14
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXS1478208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program