Provider Demographics
NPI:1518025766
Name:PAK, HO SUNG (DO)
Entity type:Individual
Prefix:
First Name:HO
Middle Name:SUNG
Last Name:PAK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:HO SUNG
Other - Last Name:PAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1672 INDEPENDENCE DR STE 310
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-3982
Mailing Address - Country:US
Mailing Address - Phone:830-730-5025
Mailing Address - Fax:830-730-4207
Practice Address - Street 1:1770 STATE HIGHWAY 46 W
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-5391
Practice Address - Country:US
Practice Address - Phone:830-730-4125
Practice Address - Fax:830-312-7896
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3819207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX201626301OtherGROUP MEDICAID
TX030713402Medicaid
TX1023028669OtherGROUP NPI
TX201626301OtherGROUP MEDICAID
TX8D9140Medicare PIN