Provider Demographics
NPI:1174911663
Name:PAEK, MIN (DMD)
Entity type:Individual
Prefix:DR
First Name:MIN
Middle Name:
Last Name:PAEK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16427 SE 35TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-5816
Mailing Address - Country:US
Mailing Address - Phone:503-544-5767
Mailing Address - Fax:
Practice Address - Street 1:26555 MAPLE VALLEY BLACK DIAMOND RD SE
Practice Address - Street 2:STE L100
Practice Address - City:MAPLE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:98038-8478
Practice Address - Country:US
Practice Address - Phone:425-385-4559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-06
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9250960-9922122300000X
WADE60680500122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist