Healthcare Provider Details

I. General information

NPI: 1871604314
Provider Name (Legal Business Name): CHARLES CHULHO BAIK DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 W LA VETA AVE STE 109
ORANGE CA
92868-4447
US

IV. Provider business mailing address

705 W LA VETA AVE STE 109
ORANGE CA
92868-4447
US

V. Phone/Fax

Practice location:
  • Phone: 714-832-7212
  • Fax: 714-832-7212
Mailing address:
  • Phone: 714-832-7212
  • Fax: 714-832-7212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE4583
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: