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General NPI Number Information
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NPI Number | 1467585448
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Entity Type | Individual
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Provider Name | JIN NAM BAEK
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Gender | Male
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Dates
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Enumeration Date | 03/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2300 N IMPERIAL AVE STE E
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City | CALEXICO
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State | CA
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Zip | 92231-3209
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Country | US
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Telephone | 760-357-1632
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Fax |
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Provider Business Mailing Address
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Address Line | 25976 LUGO DR
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City | LOMA LINDA
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State | CA
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Zip | 92354-6508
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Country | US
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Telephone | 951-756-0069
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 54709
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License Number State | CA
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