Provider Demographics
NPI:1194789149
Name:PAIK, HENRY KI (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:KI
Last Name:PAIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2341 MCCALLIE AVE
Mailing Address - Street 2:PLAZA III, SUITE 406
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3239
Mailing Address - Country:US
Mailing Address - Phone:423-648-8204
Mailing Address - Fax:423-648-8205
Practice Address - Street 1:2341 MCCALLIE AVE
Practice Address - Street 2:PLAZA III, SUITE 406
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3239
Practice Address - Country:US
Practice Address - Phone:423-648-8204
Practice Address - Fax:423-648-8205
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-14
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN27599207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ005855Medicaid
TNTN 27599OtherTN MEDICAL LICENSE NUMBER
TNQ005855Medicaid
TNTN 27599OtherTN MEDICAL LICENSE NUMBER