Provider Demographics
NPI:1023708575
Name:PAK, JENNY KATHERINE (PA)
Entity type:Individual
Prefix:MS
First Name:JENNY
Middle Name:KATHERINE
Last Name:PAK
Suffix:
Gender:F
Credentials:PA
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Other - Last Name:
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Mailing Address - Street 1:10509 HAMILTON RD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3073
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 W EDMONSTON DR STE 404
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1274
Practice Address - Country:US
Practice Address - Phone:301-762-7723
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-09
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MD363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant