Provider Demographics
NPI:1740266550
Name:PAIK, GEORGE Y (MD)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:Y
Last Name:PAIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 E THOMAS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-7767
Mailing Address - Country:US
Mailing Address - Phone:602-266-2200
Mailing Address - Fax:602-604-5046
Practice Address - Street 1:1910 E THOMAS RD STE 200
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-7767
Practice Address - Country:US
Practice Address - Phone:602-266-2200
Practice Address - Fax:602-604-5046
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30671207RC0000X, 207RI0011X
CODR.34718207RC0000X
CODR.0034718207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ722810Medicaid
Z151942Medicare PIN
E43739Medicare UPIN
AZ722810Medicaid