NPIMap

Organization Active NPI

Jaesoo Pak, MD Medical Clinic,Inc.

  • Clinic/Center
  • Cerrtios, CA
National Provider Identifier
1912187196
Registry record updated Nov 6, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
JAESOO PAK, MD MEDICAL CLINIC,INC.
Practice address
11845 South Street
Cerrtios, CA 90703-6825
Phone
(562) 809-2103
NPI assigned
Nov 6, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2007

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

Authorized official

Name
Dr. Jaesoo Pak, M.D.
Title
President
Phone
(562) 809-2103

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

11845 South Street
Cerrtios, CA 90703-6825

Mailing address

11845 South Street
Cerrtios, CA 90703-6825
Phone (562) 809-2103

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1194307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194307200000",
    "number": "1912187196",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11845 SOUTH STREET",
            "city": "CERRTIOS",
            "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 STREET",
            "city": "CERRTIOS",
            "state": "CA",
            "postal_code": "907036825",
            "telephone_number": "562-809-2103"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAESOO PAK, MD MEDICAL CLINIC,INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-06",
        "last_updated": "2007-11-06",
        "status": "A",
        "authorized_official_last_name": "PAK",
        "authorized_official_first_name": "JAESOO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "562-809-2103",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.