Provider Demographics
NPI:1457331001
Name:PAK, CHOON WHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHOON
Middle Name:WHAN
Last Name:PAK
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 1:441 S LIVERNOIS
Mailing Address - Street 2:STE 190
Mailing Address - City:ROCHESTER
Mailing Address - State:MI
Mailing Address - Zip Code:48307-2591
Mailing Address - Country:US
Mailing Address - Phone:248-656-9696
Mailing Address - Fax:
Practice Address - Street 1:1101 W UNIVERSITY
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MI
Practice Address - Zip Code:48307-2591
Practice Address - Country:US
Practice Address - Phone:248-652-5000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301031302207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B49237Medicare UPIN
F36094001Medicare ID - Type Unspecified