Individual
DR. JAE H PAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2084P0805X
Geriatric Psychiatry Physician
Primary
040185
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000678477E
—
GA
01
—
10594474
CAQH
GA
01
—
26BDJZQ
MEDICARE PTAN
GA
Enumeration date
07/22/2005
Last updated
06/03/2016
Update your record
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