Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | SP207 | CA |
NPI | 1043420037 |
---|---|
Provider Name | Dr. Eung-Kwon Pae |
First Address | Santa Monica, CA 90403-2711 |
Second Address | Los Angeles, CA 90095-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/07/2007 |