Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Jeong Sik Park MD a Prof Corp

Organization Specialist · NPI 1558524306

Jeong Sik Park MD a Prof Corp is a Specialist in Clearlake, California. Licensed in California. Registered with an NPI since 2008.

Licensed in
CA
In the registry since
2008
What do these letters mean?
Corp — Corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

15250 Lakeshore Dr Ste C
Clearlake, CA 95422-8107
Phone: (707) 995-7077
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Specialist (primary) Taxonomy 174400000X · Licence A45408 (CA)

Record details

NPI number1558524306
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Colleen Bradrick — Medical Biller · (707) 994-8818
NPI enumeratedJuly 2, 2008
Last updated in NPPESJuly 2, 2008
Mailing addressPo Box 6017, Clearlake, CA 95422-6017

Other providers in Clearlake