Healthcare Provider Details

I. General information

NPI: 1013231828
Provider Name (Legal Business Name): JOHN CHONGHOON BAIK RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S KINGSLEY DR APT. #304
LOS ANGELES CA
90020-3268
US

IV. Provider business mailing address

400 S KINGSLEY DR APT. #304
LOS ANGELES CA
90020-3268
US

V. Phone/Fax

Practice location:
  • Phone: 949-932-2440
  • Fax:
Mailing address:
  • Phone: 949-932-2440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number694781
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number3981
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: