Provider Demographics
NPI:1700946431
Name:WANDA PAK, M.D., P.C.
Entity Type:Organization
Organization Name:WANDA PAK, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-244-9404
Mailing Address - Street 1:3301 NEW MEXICO AVE., NW
Mailing Address - Street 2:SUITE 226
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-3600
Mailing Address - Country:US
Mailing Address - Phone:202-244-9404
Mailing Address - Fax:202-244-9403
Practice Address - Street 1:3301 NEW MEXICO AVE., NW
Practice Address - Street 2:SUITE 226
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-3600
Practice Address - Country:US
Practice Address - Phone:202-244-9404
Practice Address - Fax:202-244-9403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCM32178207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCG72713Medicare UPIN
DCG01708W01Medicare ID - Type Unspecified