Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | G84741 | CA |
N | 207RC0000X | Internist - Cardiovascular Disease | G84741 | CA |
NPI | 1205833811 |
---|---|
Provider Name | Dr. Peter H Pak |
First Address | Santa Monica, CA 90404-2102 |
Second Address | Santa Monica, CA 90404-2172 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2005 |
Last Update Date | 19/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F49846 | (02) | CA |