Provider Demographics
NPI:1326891532
Name:PAK, DANIEL EDWARD
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:EDWARD
Last Name:PAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3412 NE 66TH AVE APT C29
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-0200
Mailing Address - Country:US
Mailing Address - Phone:503-501-6420
Mailing Address - Fax:
Practice Address - Street 1:3412 NE 66TH AVE APT C29
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-0200
Practice Address - Country:US
Practice Address - Phone:503-501-6420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist