Provider Demographics
NPI:1861583437
Name:PAK, YONG T (MD)
Entity type:Individual
Prefix:
First Name:YONG
Middle Name:T
Last Name:PAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2120 N MACARTHUR BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-2225
Mailing Address - Country:US
Mailing Address - Phone:972-438-4636
Mailing Address - Fax:214-260-0953
Practice Address - Street 1:2120 N MACARTHUR BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-2225
Practice Address - Country:US
Practice Address - Phone:972-438-4636
Practice Address - Fax:214-260-0953
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM19962081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX206543501Medicaid
TX206543501Medicaid