Provider Demographics
NPI:1467682906
Name:PAK, SUNG YE (LMP)
Entity Type:Individual
Prefix:
First Name:SUNG
Middle Name:YE
Last Name:PAK
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 88021
Mailing Address - Street 2:
Mailing Address - City:STEILACOOM
Mailing Address - State:WA
Mailing Address - Zip Code:98388-0021
Mailing Address - Country:US
Mailing Address - Phone:253-459-4371
Mailing Address - Fax:
Practice Address - Street 1:7521 BRIDGEPORT WAY W
Practice Address - Street 2:SUITE B
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-2423
Practice Address - Country:US
Practice Address - Phone:253-241-6798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-17
Last Update Date:2009-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023361174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist