Provider Demographics
NPI:1255381299
Name:PAIK, NAREE (DDS)
Entity type:Individual
Prefix:DR
First Name:NAREE
Middle Name:
Last Name:PAIK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2321 N BOSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60614-3043
Mailing Address - Country:US
Mailing Address - Phone:773-935-3977
Mailing Address - Fax:
Practice Address - Street 1:2859 S. PULASKI ROAD 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60623-4456
Practice Address - Country:US
Practice Address - Phone:773-522-0855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1005573Medicare ID - Type Unspecified