Provider Demographics
NPI:1588955694
Name:PAK, PETER SUNGJIN (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:SUNGJIN
Last Name:PAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9550 JELLICO AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-2029
Mailing Address - Country:US
Mailing Address - Phone:818-489-0249
Mailing Address - Fax:
Practice Address - Street 1:27799 MEDICAL CENTER RD STE 440
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6400
Practice Address - Country:US
Practice Address - Phone:949-364-1007
Practice Address - Fax:949-264-0317
Is Sole Proprietor?:No
Enumeration Date:2011-04-22
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1396982086S0127X
MDD86651208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery