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General NPI Number Information
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NPI Number | 1518755354
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Entity Type | Organization
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Legal Business Name | JACLYN G PAK DDS PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 04/30/2025
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Last Update Date | 04/30/2025
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Provider Practice Location Address
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Address Line | 3111 SUNSET BLVD STE X
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City | ROCKLIN
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State | CA
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Zip | 95677-3090
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Country | US
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Telephone | 916-624-0635
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Fax |
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Provider Business Mailing Address
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Address Line | 3111 SUNSET BLVD STE X
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City | ROCKLIN
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State | CA
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Zip | 95677-3090
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Country | US
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Telephone | 916-624-0635
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JACLYN G PAK
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Credential |
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Telephone | 916-903-4082
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 292200000X
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Taxonomy Name | Dental Laboratory
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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