Provider Demographics
NPI:1477943546
Name:GENE J. PAK DDS CORPORATION
Entity Type:Organization
Organization Name:GENE J. PAK DDS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-459-7212
Mailing Address - Street 1:28562 OSO PKWY STE K
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-5599
Mailing Address - Country:US
Mailing Address - Phone:949-459-7212
Mailing Address - Fax:
Practice Address - Street 1:28562 OSO PKWY STE K
Practice Address - Street 2:
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-5599
Practice Address - Country:US
Practice Address - Phone:949-459-7212
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59385122300000X
CA27207122300000X
CA53909122300000X
CA57231122300000X
CA1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1972824589OtherTYPE 1 NPI
CA1760796023OtherTYPE 1 - NPI
CA1295856060OtherTYPE 1 - NPI
CA1235392317OtherNPI - TYPE 1