Provider Demographics
NPI:1396480844
Name:PAEK, ANDY
Entity type:Individual
Prefix:
First Name:ANDY
Middle Name:
Last Name:PAEK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7089 NORTH MARIPOSA COURT
Mailing Address - Street 2:DUBLIN, CA 94568
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94568
Mailing Address - Country:US
Mailing Address - Phone:917-208-7949
Mailing Address - Fax:
Practice Address - Street 1:424 2ND STREET
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94502
Practice Address - Country:US
Practice Address - Phone:917-208-7949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-29
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA142928101YP2500X, 101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional