Provider Demographics
NPI:1528002334
Name:PAK, SHANE S (MD)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:S
Last Name:PAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 S GARFIELD AVE
Mailing Address - Street 2:STE. 201
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-5859
Mailing Address - Country:US
Mailing Address - Phone:626-656-1324
Mailing Address - Fax:626-656-1264
Practice Address - Street 1:707 S GARFIELD AVE
Practice Address - Street 2:STE. 201
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-5859
Practice Address - Country:US
Practice Address - Phone:626-656-1324
Practice Address - Fax:626-656-1264
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52715207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery