Provider Demographics
NPI:1154538528
Name:PAK, SAE KWANG (DC)
Entity type:Individual
Prefix:DR
First Name:SAE
Middle Name:KWANG
Last Name:PAK
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8474 W 3RD ST
Mailing Address - Street 2:#204
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4139
Mailing Address - Country:US
Mailing Address - Phone:323-966-4141
Mailing Address - Fax:323-653-2356
Practice Address - Street 1:8474 W 3RD ST
Practice Address - Street 2:#204
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4139
Practice Address - Country:US
Practice Address - Phone:323-966-4141
Practice Address - Fax:323-653-2356
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC26579111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC26579Medicare ID - Type Unspecified