Provider Demographics
NPI:1053549527
Name:PAK, JENNIFER ANN (DO)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:PAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:FARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:9915 BARKER CYPRESS RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-1260
Mailing Address - Country:US
Mailing Address - Phone:281-737-1555
Mailing Address - Fax:281-737-1556
Practice Address - Street 1:9915 BARKER CYPRESS RD STE 200
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-1260
Practice Address - Country:US
Practice Address - Phone:281-737-1555
Practice Address - Fax:281-737-1556
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2020-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN8005207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine