Provider Demographics
NPI:1396881116
Name:PAK, KEI-HANG (LAC)
Entity type:Individual
Prefix:MR
First Name:KEI-HANG
Middle Name:
Last Name:PAK
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3000 COLBY ST
Mailing Address - Street 2:STE 203A
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2058
Mailing Address - Country:US
Mailing Address - Phone:510-845-8477
Mailing Address - Fax:866-929-7361
Practice Address - Street 1:3000 COLBY ST
Practice Address - Street 2:STE 203A
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2058
Practice Address - Country:US
Practice Address - Phone:510-845-8477
Practice Address - Fax:866-929-7361
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7158171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist