Provider Demographics
NPI:1457776726
Name:PAK, HENTY KIO (MPA, ASW)
Entity Type:Individual
Prefix:MR
First Name:HENTY
Middle Name:KIO
Last Name:PAK
Suffix:
Gender:M
Credentials:MPA, ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 ROSEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-4731
Mailing Address - Country:US
Mailing Address - Phone:510-885-0877
Mailing Address - Fax:510-437-8313
Practice Address - Street 1:1411 E 31ST ST
Practice Address - Street 2:SUITE E1
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1018
Practice Address - Country:US
Practice Address - Phone:510-437-4646
Practice Address - Fax:510-437-8313
Is Sole Proprietor?:No
Enumeration Date:2014-02-24
Last Update Date:2016-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X, 101Y00000X, 172V00000X, 171M00000X
CA742881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No172V00000XOther Service ProvidersCommunity Health Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical