Provider Demographics
NPI:1003177155
Name:BAEK, SHERRY (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:
Last Name:BAEK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16708 OBISPO DR
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-6593
Mailing Address - Country:US
Mailing Address - Phone:562-694-0396
Mailing Address - Fax:
Practice Address - Street 1:16406 E WHITTIER BL
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-6593
Practice Address - Country:US
Practice Address - Phone:562-694-0396
Practice Address - Fax:562-902-1184
Is Sole Proprietor?:No
Enumeration Date:2012-06-05
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA463591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice