Provider Demographics
NPI:1699844456
Name:PATRICK C E PAIK MD MED CORP
Entity Type:Organization
Organization Name:PATRICK C E PAIK MD MED CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:C E
Authorized Official - Last Name:PAIK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-280-0584
Mailing Address - Street 1:600 N GARFIELD AVENUE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1171
Mailing Address - Country:US
Mailing Address - Phone:626-280-0584
Mailing Address - Fax:626-280-3039
Practice Address - Street 1:600 N GARFIELD AVENUE
Practice Address - Street 2:SUITE 312
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1171
Practice Address - Country:US
Practice Address - Phone:626-280-0584
Practice Address - Fax:626-280-3039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32957207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A329571Medicaid
CA00A329571Medicaid
A32957Medicare ID - Type Unspecified