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General NPI Number Information
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NPI Number | 1013402718
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Entity Type | Individual
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Provider Name | DONGHWA BAEK
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Gender | Male
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 03/01/2025
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Provider Practice Location Address
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Address Line | 6565 FANNIN ST
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City | HOUSTON
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State | TX
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Zip | 77030-2703
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Country | US
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Telephone | 713-441-3490
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Fax | 713-793-1178
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Provider Business Mailing Address
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Address Line | PO BOX 4701
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City | HOUSTON
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State | TX
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Zip | 77210-4701
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Country | US
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Telephone | 800-288-8325
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | BP10064572
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | MT229978
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | U1232
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License Number State | TX
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