Provider Demographics
NPI:1407032378
Name:PAIK, JULIE JISUN (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:JISUN
Last Name:PAIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5200 EASTERN AVE STE 4100
Mailing Address - Street 2:MFL-CENTER TOWER
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-2746
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5200 EASTERN AVE STE 4100
Practice Address - Street 2:MFL-CENTER TOWER
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-2746
Practice Address - Country:US
Practice Address - Phone:443-444-4646
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-10
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101546207R00000X
MDD0075938207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine