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General NPI Number Information
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NPI Number | 1710555289
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Entity Type | Organization
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Legal Business Name | JINNAM BAEK DENTAL PRACTICE INC
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Dates
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Enumeration Date | 06/11/2021
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Last Update Date | 07/28/2021
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Provider Practice Location Address
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Address Line | 13120 PALM DR
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City | DESERT HOT SPRINGS
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State | CA
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Zip | 92240-5902
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Country | US
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Telephone | 951-550-1545
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Fax |
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Provider Business Mailing Address
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Address Line | 13120 PALM DR
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City | DESERT HOT SPRINGS
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State | CA
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Zip | 92240-5902
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Country | US
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Telephone | 951-550-1545
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | JIN NAM BAEK
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Credential |
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Telephone | 951-279-2021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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