Individual
KIRK JIHYON PAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., PH.D., M.SC.
Contact information
Practice address
W3985 COUNTY ROAD NN, ELKHORN, WI 53121-4337
(262) 741-2000
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01076965A
IN
207R00000X
Internal Medicine Physician
MD.207561
LA
208M00000X
Hospitalist Physician
01076965A
IN
208M00000X
Hospitalist Physician
Primary
85101-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001195932
ANTHEM
—
05
—
05809560
—
MS
05
—
100307369
—
WI
05
—
2196472
—
LA
05
—
300006000
—
IN
Enumeration date
05/03/2012
Last updated
03/31/2025
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