Provider Demographics
NPI:1710055298
Name:PAK, GRACE HYE WON (MD)
Entity Type:Individual
Prefix:DR
First Name:GRACE HYE WON
Middle Name:
Last Name:PAK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 5TH AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-4320
Mailing Address - Country:US
Mailing Address - Phone:212-675-7761
Mailing Address - Fax:212-242-5861
Practice Address - Street 1:51 5TH AVE
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4320
Practice Address - Country:US
Practice Address - Phone:212-675-7761
Practice Address - Fax:212-242-5861
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY199707207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYG42522Medicare UPIN
NY04U112Medicare ID - Type Unspecified