Jaesoo Pak, MD

Primary specialty

Endoscopy Clinic/CenterTaxonomy code 261QE0800X

License

05-C0001451 Issued in CA

Legal business name

JAESOO PAK, MD

Practice address

11845 South St
Cerritos, CA 90703-6825

Phone

(562) 809-2103

NPI assigned

Aug 6, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Jaesoo Pak, M.D.NPI 1023124054

Title

Medical Director

Phone

(562) 809-2103

Specialties & licenses 2

Addresses

Other names 1

• Cerritos Endoscopic Medical Center Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

Cerritos Endoscopic Medical CenterCCN 05C0001451

Medicare certification status

ActiveFrom the Provider of Services file

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jaesoo Pak, M.D.

  • Gastroenterology Physician
  • Cerritos, CA
  • NPI 1023124054
  NPD Authorized official

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

{
    "created_epoch": "1186358400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213833600000",
    "number": "1366633257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11845 SOUTH ST",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907036825",
            "telephone_number": "562-809-2103"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11845 SOUTH ST",
            "city": "CERRITOS",
            "state": "CA",
            "postal_code": "907036825",
            "telephone_number": "562-809-2103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAESOO PAK, MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-06",
        "last_updated": "2008-06-19",
        "status": "A",
        "authorized_official_last_name": "PAK",
        "authorized_official_first_name": "JAESOO",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "562-809-2103",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QE0800X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Endoscopy",
            "state": "CA",
            "license": "05-C0001451",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cerritos Endoscopic Medical Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Patience Jackson, RN
• Tekesia Marie Jackson, PSYD
• Jacqueline Jasmin Jacobo
• Kyonna Jacobs
• Reneasha Corretta Jacobs
• Arun Jain, M.D.
• Priti Jain
• Rajkumar Jaisingh, DDS
• Alyssa Janssen
• Veronica Jaramillo

• Endoscopy Clinic/Center in Cerritos, CA
• Providers in Cerritos, CA by specialty
• Endoscopy Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.