Provider Demographics
NPI:1114123726
Name:US ARMY
Entity Type:Organization
Organization Name:US ARMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:SOO
Authorized Official - Middle Name:H
Authorized Official - Last Name:BAEK
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:0505-730-2609
Mailing Address - Street 1:HHS 6-37 FA, 2ID, UNIT#15410 APO AP 15410
Mailing Address - Street 2:
Mailing Address - City:TONGDUCHON
Mailing Address - State:KYUNGKIDO
Mailing Address - Zip Code:APO AP 15410
Mailing Address - Country:KR
Mailing Address - Phone:0505-730-2609
Mailing Address - Fax:
Practice Address - Street 1:HHS 6-37FA, 2ID, UNIT#15410 APO AP 96224
Practice Address - Street 2:
Practice Address - City:TONGDUCHON
Practice Address - State:KYUNGKIDO
Practice Address - Zip Code:APO AP 96224
Practice Address - Country:KR
Practice Address - Phone:0505-730-2609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-22
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty