Provider Demographics
NPI:1790128841
Name:PAK, MARIAN (DO)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:
Last Name:PAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E. SANDPOINT
Mailing Address - Street 2:SUITE 725
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707
Mailing Address - Country:US
Mailing Address - Phone:949-722-7038
Mailing Address - Fax:
Practice Address - Street 1:1300 N VERMONT AVE STE 1001
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027
Practice Address - Country:US
Practice Address - Phone:323-473-5499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-09
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A13783207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A13783OtherMEDICAL LICENSE