Healthcare Provider Details

I. General information

NPI: 1346498474
Provider Name (Legal Business Name): SOO HYUN BAEK PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 09/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36000 DARNALL LOOP CARL R DARNALL ARMY MEDICAL CENTER
FORT HOOD TX
76544-4752
US

IV. Provider business mailing address

36000 DARNALL LOOP
FORT HOOD TX
76544-4752
US

V. Phone/Fax

Practice location:
  • Phone: 254-288-8025
  • Fax:
Mailing address:
  • Phone: 254-288-8025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: