MEDICARE: HANNAH BOHYUN BAIK DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30.025801	OH

General Provider Information

NPI Number	:	1033776844
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNAH BOHYUN BAIK DMD

Provider Business Mailing Address
First Line	:	4121 E MAIN ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2951
Country	:	US
Telephone Number	:	714-745-5288
Fax Number	:

Provider Business Practice Location Address
First Line	:	4121 E MAIN ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43213-2951
Country	:	US
Telephone Number	:	614-853-3232
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2019
Last Update Date	:	05/28/2019

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