Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 244471 | NY |
N | 208600000X | Surgeon | 244471 | NY |
N | 208200000X | Surgeon | ME128657 | FL |
N | 208600000X | Surgeon | ME128657 | FL |
Y | 2086S0120X | Pediatric Surgery | ME128657 | FL |
NPI | 1184808461 |
---|---|
Provider Name | Dr. Sang-Woo Pak |
First Address | Rockland, DE 19732-0191 |
Second Address | Jacksonville, FL 32207-8426 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/12/2007 |
Last Update Date | 10/07/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
017809300 | (05) | FL |