Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | 31954 | CO |
NPI | 1154370237 |
---|---|
Provider Name | Dr. Leo Seung Kon Paik |
First Address | Westminster, CO 80021-4895 |
Second Address | Wheat Ridge, CO 80033-6005 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/05/2006 |
Last Update Date | 17/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01319540 | (05) | CO |
G10176 | UPIN (01) | CO |