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Jeong Sik Park Md A Prof Corp
Specialist in Clearlake, California
NPI 1558524306

Jeong Sik Park Md A Prof Corp is a Specialist based in Clearlake, CA. Jeong Sik Park Md A Prof Corp practices in Clearlake, CA. The NPI Number for Jeong Sik Park Md A Prof Corp is 1558524306 and holds a License No. A45408 (California).

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

Location: 15250 Lakeshore Dr Ste C, Clearlake, CA, 95422-6017
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1558524306
Provider Name
Jeong Sik Park Md A Prof Corp
Credential
Provider Entity Type
Organization
Address
15250 Lakeshore Dr Ste C, Clearlake, CA, 95422-6017
Phone Number
707-995-7077
Fax Number
Provider Enumeration Date
07/02/2008
Last Update Date
03/09/2024
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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
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
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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