Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208100000X | Physical Medicine & Rehabilitation Doctor | MT184507 | PA |
Y | 2081S0010X | Sports Medicine | 247616-B18 | NY |
Y | 213ES0000X | Sports Medicine | 247616-B18 | NY |
NPI | 1508922527 |
---|---|
Provider Name | Kevin I Pak |
First Address | Jackson Heights, NY 11372-1049 |
Second Address | Jackson Heights, NY 11372-1049 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2006 |
Last Update Date | 16/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
03143491 | (05) | NY |