Provider Demographics
NPI:1033190913
Name:BAIK, SEUNG EUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEUNG EUN
Middle Name:
Last Name:BAIK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CRYSTAL
Other - Middle Name:S
Other - Last Name:BAIK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:9101 N GREENWOOD AVE
Mailing Address - Street 2:SUITE #202
Mailing Address - City:NILES
Mailing Address - State:IL
Mailing Address - Zip Code:60714-1499
Mailing Address - Country:US
Mailing Address - Phone:847-296-9100
Mailing Address - Fax:847-296-9101
Practice Address - Street 1:9101 N GREENWOOD AVE
Practice Address - Street 2:SUITE#202
Practice Address - City:NILES
Practice Address - State:IL
Practice Address - Zip Code:60714-1499
Practice Address - Country:US
Practice Address - Phone:847-296-9100
Practice Address - Fax:847-296-9101
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2008-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0262541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice