Provider Demographics
NPI:1346458452
Name:PAK, BYUNG HAK (DDS)
Entity Type:Individual
Prefix:DR
First Name:BYUNG
Middle Name:HAK
Last Name:PAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14720 35TH AVE
Mailing Address - Street 2:APT. 9C
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3700
Mailing Address - Country:US
Mailing Address - Phone:347-495-1018
Mailing Address - Fax:
Practice Address - Street 1:1645 GRAND CONCOURSE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10452-5810
Practice Address - Country:US
Practice Address - Phone:718-299-7012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0515131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02631845Medicaid