Healthcare Provider Details

I. General information

NPI: 1598760860
Provider Name (Legal Business Name): JOONG SEOP SOK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2005
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 WASHINGTON ST STE C
SANTA CLARA CA
95050-5975
US

IV. Provider business mailing address

1500 LOS PADRES BLVD STE 101
SANTA CLARA CA
95050-4462
US

V. Phone/Fax

Practice location:
  • Phone: 408-249-7898
  • Fax:
Mailing address:
  • Phone: 408-249-7898
  • Fax: 408-249-2800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number44778
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: