Provider Demographics
NPI:1568768323
Name:BAEK, JOSH SYUNGRUL (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSH
Middle Name:SYUNGRUL
Last Name:BAEK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:988 S FAIR OAKS AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2626
Mailing Address - Country:US
Mailing Address - Phone:626-799-4194
Mailing Address - Fax:626-799-2053
Practice Address - Street 1:988 S FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2626
Practice Address - Country:US
Practice Address - Phone:626-799-4194
Practice Address - Fax:626-799-2053
Is Sole Proprietor?:No
Enumeration Date:2011-01-26
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11390207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine