MEDICARE: DR. JOONG SEOP SOK DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	44778	CA

General Provider Information

NPI Number	:	1598760860
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOONG SEOP SOK DDS

Provider Business Mailing Address
First Line	:	1500 LOS PADRES BLVD STE 101
Second Line	:
City	:	SANTA CLARA
State	:	CA
Zip	:	95050-4462
Country	:	US
Telephone Number	:	408-249-7898
Fax Number	:	408-249-2800

Provider Business Practice Location Address
First Line	:	225 WASHINGTON ST
Second Line	:	STE C
City	:	SANTA CLARA
State	:	CA
Zip	:	95050-5975
Country	:	US
Telephone Number	:	408-249-7898
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2005
Last Update Date	:	03/09/2023

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