Provider Demographics
NPI:1184816613
Name:BAEG, JONG GAB (MTOM)
Entity Type:Individual
Prefix:MR
First Name:JONG
Middle Name:GAB
Last Name:BAEG
Suffix:
Gender:M
Credentials:MTOM
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8904 S TACOMA WAY
Mailing Address - Street 2:SUITE 6
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-4461
Mailing Address - Country:US
Mailing Address - Phone:253-983-1943
Mailing Address - Fax:253-983-9796
Practice Address - Street 1:8904 S TACOMA WAY
Practice Address - Street 2:SUITE 6
Practice Address - City:LAKEWOOD
Practice Address - State:WA
Practice Address - Zip Code:98499-4461
Practice Address - Country:US
Practice Address - Phone:253-983-1943
Practice Address - Fax:253-983-9796
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAAC00000630171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist