Provider Demographics
NPI:1306030200
Name:PAK, LYDIA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:M
Last Name:PAK
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 1:3640 LOMITA BLVD STE 207
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3954
Mailing Address - Country:US
Mailing Address - Phone:310-791-7108
Mailing Address - Fax:310-791-7142
Practice Address - Street 1:3640 LOMITA BLVD STE 307
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3960
Practice Address - Country:US
Practice Address - Phone:424-390-4036
Practice Address - Fax:424-390-4028
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51122122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist