Provider Demographics
NPI:1447389135
Name:PAIK, KANGIHNN (MD)
Entity Type:Individual
Prefix:DR
First Name:KANGIHNN
Middle Name:
Last Name:PAIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 S MCCADDEN PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-1053
Mailing Address - Country:US
Mailing Address - Phone:323-938-6706
Mailing Address - Fax:323-766-9682
Practice Address - Street 1:3188 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2421
Practice Address - Country:US
Practice Address - Phone:323-766-9688
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34525207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA84648Medicare ID - Type UnspecifiedMD