Patrick Pak, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA 15188 Issued in CA

Practice address

1307 W 6TH St
Suite 113
Corona, CA 92882-3294

Phone

(951) 278-8910

Fax

(951) 278-9895

NPI assigned

Apr 24, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• San Martin Deporres Medical Group

  • Geriatric Medicine (Family Medicine) Physician
  • Santa Ana, CA
  • NPI 1861513525
  NPD (past)

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

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1388448000000",
    "number": "1861611386",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1307 W 6TH ST",
            "address_2": "SUITE 113",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928823294",
            "telephone_number": "951-278-8910",
            "fax_number": "951-278-9895"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1307 W 6TH ST",
            "address_2": "SUITE 113",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928823294",
            "telephone_number": "951-278-8910",
            "fax_number": "951-278-9895"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAK",
        "first_name": "PATRICK",
        "name_prefix": "Mr.",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-24",
        "last_updated": "2013-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA 15188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Phil Pafford
• Kenneth Paik, D.C.
• Bryan Paine
• Jewell Angelique Painter
• Cristina Gonzales Pajarillaga-Encello, NP-BC
• Kamran Pakdamanian, DMD
• Kayvon Pakdamanian, PA
• Jayanta Kumar Pal, MD
• Vianey Palacios Maya
• Brenda L Palacios, M.S.

• Physician Assistant in Corona, CA
• Providers in Corona, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.