Healthcare Provider Details

I. General information

NPI: 1477904571
Provider Name (Legal Business Name): GB EASTERN MEDICINE CLINIC,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2016
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 BARRANCA PKWY STE 205
IRVINE CA
92604-1721
US

IV. Provider business mailing address

4010 BARRANCA PKWY STE 205
IRVINE CA
92604-1721
US

V. Phone/Fax

Practice location:
  • Phone: 714-643-6301
  • Fax:
Mailing address:
  • Phone: 714-643-6301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 17039
License Number StateCA

VIII. Authorized Official

Name: DR. GASEON BAIK
Title or Position: CEO
Credential: DAOM
Phone: 714-643-6301