Provider Demographics
NPI:1326049495
Name:PAEK, NAK YOON (MD)
Entity Type:Individual
Prefix:DR
First Name:NAK
Middle Name:YOON
Last Name:PAEK
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 1:424 N HOGAN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32202-4104
Mailing Address - Country:US
Mailing Address - Phone:904-354-5340
Mailing Address - Fax:904-354-5342
Practice Address - Street 1:424 N HOGAN ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32202-4104
Practice Address - Country:US
Practice Address - Phone:904-354-5340
Practice Address - Fax:904-354-5342
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2007-07-09
Deactivation Date:2006-03-29
Deactivation Code:
Reactivation Date:2006-06-27
Provider Licenses
StateLicense IDTaxonomies
FLME 33652207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL037599301Medicaid
FL592916480OtherINSURANCE
FL037599300Medicaid
FL172640OtherHEALTHEASE
FL213899OtherHEALTHEASE
FL15496OtherBLUE CROSS BLUE SHIELD
FL15496OtherBLUE CROSS BLUE SHIELD
FL037599301Medicaid
FL037599300Medicaid