Provider Demographics
NPI:1598872830
Name:PAK, HYUN YOUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:HYUN
Middle Name:YOUNG
Last Name:PAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SOPHIA
Other - Middle Name:YOUNG
Other - Last Name:PAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5620 SOUTHWYCK BLVD
Mailing Address - Street 2:PATHOLOGY
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-1501
Mailing Address - Country:US
Mailing Address - Phone:800-288-8325
Mailing Address - Fax:419-866-5453
Practice Address - Street 1:1401 S GRAND AVE
Practice Address - Street 2:PATHOLOGY
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3010
Practice Address - Country:US
Practice Address - Phone:213-742-5796
Practice Address - Fax:213-742-6373
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29601207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A296010Medicaid
CAWA29601BMedicare ID - Type Unspecified
CAA87252Medicare UPIN