Provider Demographics
NPI:1497074595
Name:PAK, SEON A (LAC)
Entity Type:Individual
Prefix:DR
First Name:SEON
Middle Name:A
Last Name:PAK
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2709 BAYCREST PL.
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833
Mailing Address - Country:US
Mailing Address - Phone:714-244-2584
Mailing Address - Fax:714-879-2938
Practice Address - Street 1:2709 BAYCREST PL
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-1404
Practice Address - Country:US
Practice Address - Phone:714-244-2584
Practice Address - Fax:714-879-2938
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-28
Last Update Date:2010-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 9761171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist