1518025766 NPI number — HO SUNG PAK DO

Table of content: HO SUNG PAK DO (NPI 1518025766)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518025766 NPI number — HO SUNG PAK DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAK
Provider First Name:
HO
Provider Middle Name:
SUNG
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PAK
Provider Other First Name:
DAVID
Provider Other Middle Name:
HO SUNG
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DO
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1518025766
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1672 INDEPENDENCE DR STE 310
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BRAUNFELS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78132-3982
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-730-5025
Provider Business Mailing Address Fax Number:
830-730-4207

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1770 STATE HIGHWAY 46 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BRAUNFELS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78132-5391
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-730-4125
Provider Business Practice Location Address Fax Number:
830-312-7896
Provider Enumeration Date:
12/04/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  K3819 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: K3819 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 201626301 . This is a "GROUP MEDICAID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 030713402 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1023028669 . This is a "GROUP NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".