Provider Demographics
NPI:1912019563
Name:PAIK-TESCH, JOHN BERNARD (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BERNARD
Last Name:PAIK-TESCH
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:PO BOX 3768
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95344-3768
Mailing Address - Country:US
Mailing Address - Phone:209-725-3122
Mailing Address - Fax:209-725-3128
Practice Address - Street 1:3385 G ST STE A
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-0980
Practice Address - Country:US
Practice Address - Phone:209-725-3122
Practice Address - Fax:209-725-3128
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2019-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75912207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G759120Medicaid
CAF90637Medicare UPIN
CA00G759120Medicare PIN