Provider Demographics
NPI:1578642732
Name:PAIK, SEUNG W (MD)
Entity Type:Individual
Prefix:
First Name:SEUNG
Middle Name:W
Last Name:PAIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:4200 DANIELS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ANNANDALE
Mailing Address - State:VA
Mailing Address - Zip Code:22003-3149
Mailing Address - Country:US
Mailing Address - Phone:703-256-1322
Mailing Address - Fax:703-256-1325
Practice Address - Street 1:4200 DANIELS AVE STE 100
Practice Address - Street 2:
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-3149
Practice Address - Country:US
Practice Address - Phone:703-256-1322
Practice Address - Fax:703-256-1325
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101029691207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC88870Medicare UPIN