Provider Demographics
NPI:1275675977
Name:PAIK, JOHN KWANGDEOK (LAC DOM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:KWANGDEOK
Last Name:PAIK
Suffix:
Gender:M
Credentials:LAC DOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 CAMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-4047
Mailing Address - Country:US
Mailing Address - Phone:626-922-9492
Mailing Address - Fax:
Practice Address - Street 1:2015 CAMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-4047
Practice Address - Country:US
Practice Address - Phone:626-922-9492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7383171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist