Healthcare Provider Details

I. General information

NPI: 1598886681
Provider Name (Legal Business Name): JOHN W PAK D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1966 DEL PASO RD STE 100
SACRAMENTO CA
95834-7723
US

IV. Provider business mailing address

4881 OLIVE BLOSSOM DR
ROSEVILLE CA
95747-7560
US

V. Phone/Fax

Practice location:
  • Phone: 916-928-9212
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number112883
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: