Provider Demographics
NPI:1255028064
Name:GATES, CHRISTINE PAEK
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:PAEK
Last Name:GATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40202 SANTA TERESA CMN
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-3629
Mailing Address - Country:US
Mailing Address - Phone:650-539-9108
Mailing Address - Fax:
Practice Address - Street 1:40202 SANTA TERESA CMN
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-3629
Practice Address - Country:US
Practice Address - Phone:650-539-9108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-20
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program