Provider Demographics
NPI:1619151925
Name:PARK-LIN, JAE E (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAE
Middle Name:E
Last Name:PARK-LIN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 PEABODY RD.
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687
Mailing Address - Country:US
Mailing Address - Phone:707-451-0182
Mailing Address - Fax:707-454-3485
Practice Address - Street 1:2100 PEABODY RD.
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687
Practice Address - Country:US
Practice Address - Phone:707-451-0182
Practice Address - Fax:707-454-3485
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-21
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48532122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA48532OtherCA. STATE PRISON SOLANO