Provider Demographics
NPI:1497847834
Name:PAK, HAE YOUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:HAE
Middle Name:YOUNG
Last Name:PAK
Suffix:
Gender:F
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:#12 ESTATE BELIEVUE
Mailing Address - Street 2:
Mailing Address - City:ST. THOMAS
Mailing Address - State:VI
Mailing Address - Zip Code:00801
Mailing Address - Country:US
Mailing Address - Phone:340-776-2972
Mailing Address - Fax:
Practice Address - Street 1:VI MEDICAL FOUNDATION BUILDING
Practice Address - Street 2:SUITE 104
Practice Address - City:ST. THOMAS
Practice Address - State:VI
Practice Address - Zip Code:00802
Practice Address - Country:US
Practice Address - Phone:340-774-0362
Practice Address - Fax:340-775-0154
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI31208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VIAP9403661OtherPEDIATRIC