Provider Demographics
NPI:1770702680
Name:PAIK, EUN JU
Entity type:Individual
Prefix:DR
First Name:EUN
Middle Name:JU
Last Name:PAIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3441 W BALL RD STE A
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-3767
Mailing Address - Country:US
Mailing Address - Phone:657-337-5117
Mailing Address - Fax:844-387-9352
Practice Address - Street 1:3441 W BALL RD STE A
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-3767
Practice Address - Country:US
Practice Address - Phone:657-337-5117
Practice Address - Fax:844-387-9352
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55545122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD55545Medicaid