Provider Demographics
NPI:1972824589
Name:PAK, GENE J (DDS)
Entity Type:Individual
Prefix:DR
First Name:GENE
Middle Name:J
Last Name:PAK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:28562 OSO PKWY
Mailing Address - Street 2:STE K
Mailing Address - City:RANCHO SANTA MARGARITA
Mailing Address - State:CA
Mailing Address - Zip Code:92688-5599
Mailing Address - Country:US
Mailing Address - Phone:949-459-7212
Mailing Address - Fax:
Practice Address - Street 1:28562 OSO PKWY
Practice Address - Street 2:STE K
Practice Address - City:RANCHO SANTA MARGARITA
Practice Address - State:CA
Practice Address - Zip Code:92688-5595
Practice Address - Country:US
Practice Address - Phone:714-397-3366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA593851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice