Healthcare Provider Details

I. General information

NPI: 1124031232
Provider Name (Legal Business Name): BAEK YOUNG CHOUNG D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24900 HIGHWAY 202
TEHACHAPI CA
93561-5558
US

IV. Provider business mailing address

8653 FLORENCE AVE
DOWNEY CA
90240-4032
US

V. Phone/Fax

Practice location:
  • Phone: 661-822-4402
  • Fax:
Mailing address:
  • Phone: 562-622-0066
  • Fax: 562-869-7541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number46770
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: