Provider Demographics
NPI:1518966654
Name:BAEK, MIJUNG (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MIJUNG
Middle Name:
Last Name:BAEK
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9203
Mailing Address - Street 2:ANESTHEISA ASSOCIATES LTD.
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-0203
Mailing Address - Country:US
Mailing Address - Phone:703-931-2080
Mailing Address - Fax:703-845-7463
Practice Address - Street 1:4320 SEMINARY RD
Practice Address - Street 2:INOVA ALEXANDRIA HOSPITAL
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-1535
Practice Address - Country:US
Practice Address - Phone:703-931-2080
Practice Address - Fax:703-845-7463
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001181392163W00000X
VA0024165650367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
010156A50Medicare ID - Type Unspecified