Basic Information
Provider Information | |||||||||
NPI: | 1649406141 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | PAIK | ||||||||
FirstName: | TOMALIKA | ||||||||
MiddleName: | AHSAN | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | AHSAN-PAIK | ||||||||
OtherFirstName: | TOMALIKA | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: | DR. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 3315 WATT AVE | ||||||||
Address2: |   | ||||||||
City: | SACRAMENTO | ||||||||
State: | CA | ||||||||
PostalCode: | 958213600 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9164816800 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 901 CAMPUS DRIVE | ||||||||
Address2: | SUITE 102 | ||||||||
City: | DALY CITY | ||||||||
State: | CA | ||||||||
PostalCode: | 940154930 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4156420707 | ||||||||
FaxNumber: | 6507558638 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/10/2009 | ||||||||
LastUpdateDate: | 08/28/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | A116369 | CA | Y |   | Allopathic & Osteopathic Physicians | Anesthesiology |   |
No ID Information.