Healthcare Provider Details

I. General information

NPI: 1265360705
Provider Name (Legal Business Name): JOSHUA MIN BAEK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5480 PHILADELPHIA ST STE C
CHINO CA
91710-2486
US

IV. Provider business mailing address

3020 LA PAZ LN UNIT E
DIAMOND BAR CA
91765-3850
US

V. Phone/Fax

Practice location:
  • Phone: 626-333-8877
  • Fax:
Mailing address:
  • Phone: 213-431-7457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number37587
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: