Provider Demographics
NPI:1407000243
Name:PAK, SUNGMIN (DC, LAC)
Entity Type:Individual
Prefix:
First Name:SUNGMIN
Middle Name:
Last Name:PAK
Suffix:
Gender:M
Credentials:DC, LAC
Other - Prefix:
Other - First Name:SHAWN
Other - Middle Name:
Other - Last Name:PAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DC,LAC
Mailing Address - Street 1:11734 ARTESIA BLVD
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-3804
Mailing Address - Country:US
Mailing Address - Phone:562-809-8669
Mailing Address - Fax:562-809-8122
Practice Address - Street 1:11734 ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-3804
Practice Address - Country:US
Practice Address - Phone:562-809-8669
Practice Address - Fax:562-809-8122
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-06
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR008322111N00000X
CA19938111N00000X
CA5127171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No111N00000XChiropractic ProvidersChiropractor