Provider Demographics
NPI:1770679631
Name:PAEK, JASON S (MD)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:S
Last Name:PAEK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18773 COLIMA RD
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-2949
Mailing Address - Country:US
Mailing Address - Phone:626-986-4899
Mailing Address - Fax:626-986-4855
Practice Address - Street 1:18773 COLIMA RD
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-2949
Practice Address - Country:US
Practice Address - Phone:626-986-4899
Practice Address - Fax:626-986-4855
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2019-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58208207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G582081Medicaid
CA912171732OtherBLUE CROSS
00G582080OtherBLUE SHIELD
0004332734OtherAETNA
CA912171732AOtherHEALTH NET
CATRICAREOther912171732 91789 A001