Provider Demographics
NPI:1518155977
Name:KYE C PAHK
Entity Type:Organization
Organization Name:KYE C PAHK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KYE
Authorized Official - Middle Name:C
Authorized Official - Last Name:PAHK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-382-0333
Mailing Address - Street 1:6801 US 27 N
Mailing Address - Street 2:C2
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-7840
Mailing Address - Country:US
Mailing Address - Phone:862-382-0333
Mailing Address - Fax:863-382-8777
Practice Address - Street 1:6801 US 27 N
Practice Address - Street 2:C2
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-7840
Practice Address - Country:US
Practice Address - Phone:862-382-0333
Practice Address - Fax:863-382-8777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2007-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6184Medicare PIN