Provider Demographics
NPI:1538218441
Name:PAEK, BETTINA W (MD)
Entity type:Individual
Prefix:DR
First Name:BETTINA
Middle Name:W
Last Name:PAEK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6815 SE 33RD ST
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3302
Mailing Address - Country:US
Mailing Address - Phone:206-230-4290
Mailing Address - Fax:206-230-4290
Practice Address - Street 1:1959 NE PACIFIC ST # 356460
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98195-6460
Practice Address - Country:US
Practice Address - Phone:206-598-0003
Practice Address - Fax:206-616-9479
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00043865207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8395881Medicaid
WA106229Medicare UPIN
WA8395881Medicaid