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Jeong Sik Park, MD
Specialist in Clearlake, California
NPI 1528078961

Jeong Sik Park is a Specialist based in Clearlake, CA. Jeong Sik Park practices in Clearlake, CA and has the professional credentials of MD. The NPI Number for Jeong Sik Park is 1528078961 and holds a License No. A45408 (California).

The current practice location address for Jeong Sik Park is 15250 Lakeshore Dr Ste C, Clearlake, CA and can be reached out via phone at 707-995-7077 and via fax at 707-995-0904.

Location: 15250 Lakeshore Dr Ste C, Clearlake, CA, 95422-6017
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1528078961
Provider Name
Jeong Sik Park
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
15250 Lakeshore Dr Ste C, Clearlake, CA, 95422-6017
Phone Number
707-995-7077
Fax Number
707-995-0904
Provider Enumeration Date
08/08/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
00A454080 05 CA
institution
Provider Business Practice Location Address Details
Address
15250 Lakeshore Dr Ste C
City
Clearlake
State
California
Zip
95422-8107
Phone Number
707-995-7077
Fax Number
707-995-0904
person
Provider Business Mailing Address Details
Address
15250 Lakeshore Dr Ste C
City
Clearlake
State
California
Zip
95422-8107
Phone Number
707-995-7077
Fax Number
707-995-0904
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
A45408 (California)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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