Provider Demographics
NPI:1972501575
Name:PAIK, SEUNG WOOK (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEUNG WOOK
Middle Name:
Last Name:PAIK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:S
Other - Last Name:PAIK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3640 S NOGALES ST
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91792-2714
Mailing Address - Country:US
Mailing Address - Phone:626-810-4248
Mailing Address - Fax:
Practice Address - Street 1:3640 S NOGALES ST
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91792-2714
Practice Address - Country:US
Practice Address - Phone:626-810-4248
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA287811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB28781-01Medicaid