Individual
DR. JAESOO PAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
11841 SOUTH ST, CERRITOS, CA 90703-6825
(562) 809-8082
Mailing address
11841 SOUTH ST, CERRITOS, CA 90703-6825
(562) 809-8082
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
G77845
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G077845
—
CA
01
—
G77845
MEDICAL LICENSE NUMBER
CA
Enumeration date
08/22/2006
Last updated
07/09/2007
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