Healthcare Provider Details

I. General information

NPI: 1922022219
Provider Name (Legal Business Name): SHARON SUNGHEE BAEK D.C., L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9681 GARDEN GROVE BLVD STE 101-102
GARDEN GROVE CA
92844-1541
US

IV. Provider business mailing address

9681 GARDEN GROVE BLVD STE 101-102
GARDEN GROVE CA
92844-1541
US

V. Phone/Fax

Practice location:
  • Phone: 714-530-7001
  • Fax: 714-530-7261
Mailing address:
  • Phone: 714-530-7001
  • Fax: 714-530-7261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NX0800X
TaxonomyOrthopedic Chiropractor
License NumberDC22627
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC 22627
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code111NR0200X
TaxonomyRadiology Chiropractor
License NumberDC22627
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberDC22627
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC14975
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: