Provider Demographics
NPI:1467504225
Name:YUNCHUL JOHN PAK MD INC
Entity Type:Organization
Organization Name:YUNCHUL JOHN PAK MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YUNCHUL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-337-7267
Mailing Address - Street 1:1433 W MERCED AVE
Mailing Address - Street 2:#205
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790
Mailing Address - Country:US
Mailing Address - Phone:626-337-7267
Mailing Address - Fax:626-337-6847
Practice Address - Street 1:1433 W MERCED AVE
Practice Address - Street 2:#205
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790
Practice Address - Country:US
Practice Address - Phone:626-337-7267
Practice Address - Fax:626-337-6847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2014-08-19
Deactivation Date:2013-08-07
Deactivation Code:
Reactivation Date:2014-08-19
Provider Licenses
StateLicense IDTaxonomies
CAA38260208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty