Jeong Sik Park MD a Prof Corp

Primary specialty

SpecialistTaxonomy code 174400000X

License

A45408 Issued in CA

Legal business name

JEONG SIK PARK MD A PROF CORP

Practice address

15250 Lakeshore Dr Ste C
Clearlake, CA 95422-8107

Phone

(707) 995-7077

NPI assigned

Jul 2, 2008

Organization subpart

No

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

Authorized official

Name

Colleen Bradrick

Title

Medical Biller

Phone

(707) 994-8818

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1214956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214956800000",
    "number": "1558524306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6017",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954226017",
            "telephone_number": "707-995-7077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15250 LAKESHORE DR STE C",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954228107",
            "telephone_number": "707-995-7077"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JEONG SIK PARK MD A PROF CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-02",
        "last_updated": "2008-07-02",
        "status": "A",
        "authorized_official_last_name": "BRADRICK",
        "authorized_official_first_name": "COLLEEN",
        "authorized_official_title_or_position": "MEDICAL BILLER",
        "authorized_official_telephone_number": "707-994-8818"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "A45408",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A454080",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jack M. Elizares Optometric Corporation
• Claire Elise Jacobs
• Austin Jacquillard
• Jennifer a Dowalter MD a Professional Corporation
• Raymond Dean Jennings, MD
• JJ&R Emergency Medical Group of California, Inc.
• Candieda Lee-Denise Johnson
• Elise Patricia Anne Jones
• Katarina Juhaszova, PA-C
• Volodymyr Karpa, M.D.

• Specialist in Clearlake, CA
• Providers in Clearlake, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.