Healthcare Provider Details

I. General information

NPI: 1598389629
Provider Name (Legal Business Name): ANNABEL EUJUNG BAEK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNABEL KANG

II. Dates (important events)

Enumeration Date: 06/04/2020
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1145 OLENTANGY RIVER RD
COLUMBUS OH
43212-3117
US

IV. Provider business mailing address

700 ACKERMAN RD STE 2120
COLUMBUS OH
43202-1559
US

V. Phone/Fax

Practice location:
  • Phone: 614-293-0223
  • Fax: 614-293-7232
Mailing address:
  • Phone: 614-293-0223
  • Fax: 614-293-7232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number35.156186
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: