Individual
DR. JAMES PYONG-KON PAK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
815 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2224
(817) 321-0387
Mailing address
816 W CANNON ST, FORT WORTH, TX 76104-3146
(817) 321-0387
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
K2256
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1377236-17
—
TX
05
—
137723613
—
TX
05
—
137723615
—
TX
Enumeration date
07/22/2005
Last updated
08/15/2012
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