Basic Information
| Provider Information | |||||||||
| NPI: | 1255560967 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAIK | ||||||||
| FirstName: | AIMEE | ||||||||
| MiddleName: | SOYUN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1033 LOS PALOS DR | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939013916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8316491000 | ||||||||
| FaxNumber: | 8316494962 | ||||||||
| Practice Location | |||||||||
| Address1: | 1033 LOS PALOS DR | ||||||||
| Address2: | |||||||||
| City: | SALINAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 939013916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8317572058 | ||||||||
| FaxNumber: | 8317570232 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2009 | ||||||||
| LastUpdateDate: | 05/10/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | A110747 | CA | Y | Allopathic & Osteopathic Physicians | Dermatology |
ID Information
| ID | Type | State | Issuer | Description | 1083863468 | 01 | CENTRAL COAST DERMATOLOGY, INC. GROUP NPI NUMBER FOR BILLING | OTHER |