Provider Demographics
NPI:1194715912
Name:PAK, LAURA K (MD)
Entity type:Individual
Prefix:DR
First Name:LAURA
Middle Name:K
Last Name:PAK
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Gender:F
Credentials:MD
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Mailing Address - Street 1:1100 S ELISEO DR
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2017
Mailing Address - Country:US
Mailing Address - Phone:415-464-5400
Mailing Address - Fax:415-464-5413
Practice Address - Street 1:1100 S ELISEO DR
Practice Address - Street 2:SUITE 2A
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2017
Practice Address - Country:US
Practice Address - Phone:415-464-5400
Practice Address - Fax:415-464-5413
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2013-08-05
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Provider Licenses
StateLicense IDTaxonomies
CAA603652086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH49254Medicare UPIN