Provider Demographics
NPI:1811109903
Name:PAK, YONG S (MSW LSW)
Entity type:Individual
Prefix:
First Name:YONG
Middle Name:S
Last Name:PAK
Suffix:
Gender:F
Credentials:MSW LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 W HORIZON RIDGE PKWY
Mailing Address - Street 2:STE 120
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-5082
Mailing Address - Country:US
Mailing Address - Phone:702-294-0433
Mailing Address - Fax:
Practice Address - Street 1:4495 W HACIENDA AVE STE 3
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89118-1541
Practice Address - Country:US
Practice Address - Phone:702-385-5331
Practice Address - Fax:702-385-5678
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV4432-S1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical