Healthcare Provider Details

I. General information

NPI: 1760143895
Provider Name (Legal Business Name): MINAH BAEK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2021
Last Update Date: 12/30/2021
Certification Date: 12/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 E 31ST ST
OAKLAND CA
94602-1092
US

IV. Provider business mailing address

10569 ENGLEWOOD DR
OAKLAND CA
94605-5013
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-6463
  • Fax:
Mailing address:
  • Phone: 707-567-7320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number703320
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: