Provider Demographics
NPI:1396945762
Name:PARK, JISOOK FRANCES (DDS)
Entity type:Individual
Prefix:MS
First Name:JISOOK
Middle Name:FRANCES
Last Name:PARK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:J
Other - Middle Name:FRANCES
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:2021 YGNACIO VALLEY ROAD
Mailing Address - Street 2:SUITE B-4
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598
Mailing Address - Country:US
Mailing Address - Phone:925-977-8230
Mailing Address - Fax:929-932-1150
Practice Address - Street 1:2021 YGNACIO VALLEY ROAD
Practice Address - Street 2:SUITE B-4
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598
Practice Address - Country:US
Practice Address - Phone:925-977-8230
Practice Address - Fax:929-932-1150
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45307122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist