Provider Demographics
NPI:1518755354
Name:JACLYN G PAK DDS PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:JACLYN G PAK DDS PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JACLYN
Authorized Official - Middle Name:G
Authorized Official - Last Name:PAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-903-4082
Mailing Address - Street 1:3111 SUNSET BLVD STE X
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95677-3090
Mailing Address - Country:US
Mailing Address - Phone:916-624-0635
Mailing Address - Fax:
Practice Address - Street 1:3111 SUNSET BLVD STE X
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95677-3090
Practice Address - Country:US
Practice Address - Phone:916-624-0635
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-30
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No292200000XLaboratoriesDental Laboratory