Provider Demographics
NPI:1912393505
Name:PAIK, PETER KIM (PT)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:KIM
Last Name:PAIK
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6670 ALTON PKWY
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3734
Mailing Address - Country:US
Mailing Address - Phone:949-932-7979
Mailing Address - Fax:
Practice Address - Street 1:9201 W SUNSET BLVD STE M120
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-3714
Practice Address - Country:US
Practice Address - Phone:310-246-1050
Practice Address - Fax:866-774-9459
Is Sole Proprietor?:No
Enumeration Date:2015-04-09
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 42193225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist