Provider Demographics
NPI:1558144378
Name:PAIK, KWONG
Entity Type:Individual
Prefix:
First Name:KWONG
Middle Name:
Last Name:PAIK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:KWONG
Other - Middle Name:
Other - Last Name:SIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:99-1300 HALAWA VALLEY ST
Mailing Address - Street 2:
Mailing Address - City:AIEA
Mailing Address - State:HI
Mailing Address - Zip Code:96701-3289
Mailing Address - Country:US
Mailing Address - Phone:808-238-1671
Mailing Address - Fax:
Practice Address - Street 1:99-1300 HALAWA VALLEY ST
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-3289
Practice Address - Country:US
Practice Address - Phone:808-238-1671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health