Provider Demographics
NPI:1972624773
Name:PAIK, PATRICK C (MD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:C
Last Name:PAIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:600 N GARFIELD AVE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1171
Mailing Address - Country:US
Mailing Address - Phone:626-280-0584
Mailing Address - Fax:626-280-3039
Practice Address - Street 1:600 N GARFIELD AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1171
Practice Address - Country:US
Practice Address - Phone:626-280-0584
Practice Address - Fax:626-280-3039
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA32957207R00000X, 207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA32957Medicare PIN