Jaclyn G Pak, DDS, MS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

62615 Issued in CA

Practice address

1850 Spring Ridge Dr
Susanville, CA 96130-6100

Phone

(530) 251-5000

NPI assigned

Jun 28, 2012

Reactivated

May 7, 2026

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Jaclyn G Pak DDS Ms Dental Sleep Medicine Inc

  • General Practice Dentistry
  • Rocklin, CA
  • NPI 1508714098
  NPD Authorized official
• Jaclyn G Pak DDS Professional Corporation

  • Customized Equipment (DME)
  • Rocklin, CA
  • NPI 1518755354
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1340841600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778112000000",
    "number": "1427312099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1850 SPRING RIDGE DR",
            "city": "SUSANVILLE",
            "state": "CA",
            "postal_code": "961306100",
            "telephone_number": "530-251-5000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 SPRING RIDGE DR",
            "city": "SUSANVILLE",
            "state": "CA",
            "postal_code": "961306100",
            "telephone_number": "530-251-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PAK",
        "first_name": "JACLYN",
        "middle_name": "G",
        "credential": "DDS, MS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-28",
        "last_updated": "2026-05-07",
        "deactivation_date": "2026-03-19",
        "reactivation_date": "2026-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "62615",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Terri Kathleen O'Bryan, ACSW
• Denise Lyn Ogburn
• Lenis Yaneth Oseguera
• Owens, Inc.
• Owl Intervention Sevices
• Anthony Pangallo
• Roberta Pangallo
• Sukhbir S Pannu, MD
• Stacy Patrick
• Charles Gregory Pendarvis Jr.

• General Practice Dentistry in Susanville, CA
• Providers in Susanville, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.