Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | A101637 | CA |
Y | 2080N0001X | Neonatal-Perinatal Doctor | S2449 | TX |
NPI | 1023209327 |
---|---|
Provider Name | Sung Hyun Paek |
First Address | Richardson, TX 75082-3552 |
Second Address | Richardson, TX 75082-3552 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2007 |
Last Update Date | 20/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
FHC70593F | (05) | CA |
W1508 | CHC-COASTAL MEDICAL CENTER -MEDICARE GROUP NUMBER (01) | CA |
ZZZ52117Z | BLUE SHIELD # (01) | CA |