Provider Demographics
NPI:1649271362
Name:PAK, WESLEY KWUNGSUH (DC)
Entity type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:KWUNGSUH
Last Name:PAK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2224 GROUSE WAY
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-4613
Mailing Address - Country:US
Mailing Address - Phone:510-429-7651
Mailing Address - Fax:
Practice Address - Street 1:1807 SANTA RITA RD
Practice Address - Street 2:SUITE D
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-4779
Practice Address - Country:US
Practice Address - Phone:925-846-2225
Practice Address - Fax:925-846-2230
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC27836111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor