Provider Demographics
NPI:1396813721
Name:JO, PAUL KISUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:KISUNG
Last Name:JO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 O ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-6410
Mailing Address - Country:US
Mailing Address - Phone:916-736-2801
Mailing Address - Fax:916-736-2071
Practice Address - Street 1:2801 O ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6410
Practice Address - Country:US
Practice Address - Phone:916-736-2801
Practice Address - Fax:916-736-2071
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA489221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice