Provider Demographics
NPI:1487409108
Name:PAEK, GENA
Entity type:Individual
Prefix:
First Name:GENA
Middle Name:
Last Name:PAEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1150 10TH AVE NE APT 325
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-7482
Mailing Address - Country:US
Mailing Address - Phone:254-289-3881
Mailing Address - Fax:
Practice Address - Street 1:1416 HIGHLANDS DR NE STE 120
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98029-6240
Practice Address - Country:US
Practice Address - Phone:425-557-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-18
Last Update Date:2025-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA616766261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice