Healthcare Provider Details

I. General information

NPI: 1922492487
Provider Name (Legal Business Name): SUNG BAEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 01/29/2024
Certification Date: 08/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRIAN D. ALLGOOD ARMY COMMUNITY HOSPITAL (BDAACH) UNIT #15245 BLDG 3031
APO AP
96271
US

IV. Provider business mailing address

BRIAN D. ALLGOOD ARMY COMMUNITY HOSPITAL (BDAACH) UNIT #15245 BLDG 3031
APO AP
96271
US

V. Phone/Fax

Practice location:
  • Phone: 315-737-5658
  • Fax:
Mailing address:
  • Phone: 315-737-2019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number29841
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: