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JEONG SIK PARK MD A PROF CORP
NPI 1558524306
Specialist in Clearlake, CA

Active since July 02, 2008
15250 LAKESHORE DR STE C, CLEARLAKE, CA 95422(707) 995-7077 Get Directions Write a Review

NPPES record last updated: July 2, 2008. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Jeong Sik Park Md A Prof Corp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JEONG SIK PARK MD A PROF CORP (NPI 1558524306) is a healthcare organization registered as a specialist in Clearlake, California and active in the NPI registry since July 2008. The organization lists Colleen Bradrick, Medical Biller, as its authorized official.

NPPES Registry Identity

NPI1558524306
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameJEONG SIK PARK MD A PROF CORP
Location Address15250 LAKESHORE DR STE CClearlake, CA 95422-8107
Mailing AddressPo Box 6017Clearlake, CA 95422-6017 · (707) 995-7077
Phone(707) 995-7077
Organization SubpartNo
Authorized OfficialColleen BradrickMedical Biller · (707) 994-8818
Enumeration DateJuly 2, 2008
✔ NPI 1558524306 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in CA · A45408
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.
15250 LAKESHORE DR STE C, Clearlake, CA 95422
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Other Identifiers 1

Medicaid00A454080CA

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 3

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

JEONG SIK PARK M.D.
Specialist
15250 LAKESHORE DR STE C
CLEARLAKE, CA 95422
Lake County (707) 995-7077
LAKE SILVERADO CARDIOVASCULAR CONSULTANTS
Specialist
15250 LAKESHORE DR STE C
CLEARLAKE, CA 95422
Lake County (707) 995-7077
WHIE OH MD
Internal Medicine (Interventional Cardiology)
15250 LAKESHORE DR STE C
CLEARLAKE, CA 95422
Lake County (707) 995-3764

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jeong Sik Park MD A Prof Corp's NPI number?

The NPI number for Jeong Sik Park MD A Prof Corp is 1558524306. It was assigned to this organization in the NPPES registry on July 2, 2008.

Where is Jeong Sik Park MD A Prof Corp located?

Jeong Sik Park MD A Prof Corp is located at 15250 Lakeshore Dr Ste C, Clearlake, CA 95422. The listed phone number is (707) 995-7077.

What is Jeong Sik Park MD A Prof Corp's specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

When was this NPI record last updated?

The NPPES record for Jeong Sik Park MD A Prof Corp was last updated on July 2, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.