Provider Demographics
NPI:1407131089
Name:PAK, ANGELA (LAC)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:
Last Name:PAK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14211 38TH AVE
Mailing Address - Street 2:FL#1
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5520
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14211 38TH AVE
Practice Address - Street 2:FL#1
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5520
Practice Address - Country:US
Practice Address - Phone:718-353-6702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004646-1171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist