Provider Demographics
NPI:1619133477
Name:PAE, TOMIE KANG (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:TOMIE
Middle Name:KANG
Last Name:PAE
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 SAN JULIAN ST
Mailing Address - Street 2:BUILDING 2
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3142
Mailing Address - Country:US
Mailing Address - Phone:213-765-2800
Mailing Address - Fax:
Practice Address - Street 1:1430 SAN JULIAN ST
Practice Address - Street 2:BUILDING 2
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3142
Practice Address - Country:US
Practice Address - Phone:213-765-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA223722363LS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool