Healthcare Provider Details

I. General information

NPI: 1104766344
Provider Name (Legal Business Name): IN YUB BAEK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ISAAC YUB BAEK MD

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 DE SOTO AVE
WOODLAND HILLS CA
91367-6798
US

IV. Provider business mailing address

71 PENNSYLVANIA AVE APT 2
SOMERVILLE MA
02145-2227
US

V. Phone/Fax

Practice location:
  • Phone: 818-719-4828
  • Fax:
Mailing address:
  • Phone: 860-387-5797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: