Pak Podiatry Corp

Primary specialty

Podiatric Clinic/CenterTaxonomy code 261QP1100X

License

E4251 Issued in CA

Legal business name

PAK PODIATRY CORP

Practice address

1123 S Central Ave
Glendale, CA 91204-2212

Phone

(818) 242-8805

Fax

(818) 242-4442

NPI assigned

Feb 7, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. James(Sang) Joon Pak, D.P.M

Title

Owner

Phone

(818) 242-8805

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs on the same Medicare enrollment 2

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Pak Podiatry Corp.

  • Podiatric Clinic/Center
  • Los Angeles, CA
  • NPI 1396796306

  O20040615001353

  Same enrollment
• Pak Podiatry Corp.

  • Podiatric Clinic/Center
  • Van Nuys, CA
  • NPI 1528194925

  O20040615001353

  Same enrollment

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194480000000",
    "number": "1245370444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1123 S CENTRAL AVE",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912042212",
            "telephone_number": "818-242-8805",
            "fax_number": "818-242-4442"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1123 S CENTRAL AVE",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912042212",
            "telephone_number": "818-242-8805",
            "fax_number": "818-242-4442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAK PODIATRY CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2007-11-08",
        "status": "A",
        "authorized_official_last_name": "PAK",
        "authorized_official_first_name": "JAMES(SANG)",
        "authorized_official_middle_name": "JOON",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "818-242-8805",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.P.M"
    },
    "taxonomies": [
        {
            "code": "261QP1100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Podiatric",
            "state": "CA",
            "license": "E4251",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Daniel Padron
• Mark E Page, DDS
• Pilar Paguia
• Liana Paik, ASW
• Ashley Amelia Painter, RD
• Joo Chon Pak, L AC
• Myung Soon Pak, L AC
• Brian Palacios S Nchez
• Jorge Luis Palacios
• Miguel Palacios Jr.

• Podiatric Clinic/Center in Glendale, CA
• Providers in Glendale, CA by specialty
• Podiatric Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.