Provider Demographics
NPI:1609018381
Name:JIN NAM BAEK, DDS, INC.
Entity Type:Organization
Organization Name:JIN NAM BAEK, DDS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JIN
Authorized Official - Middle Name:NAM
Authorized Official - Last Name:BAEK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-336-0420
Mailing Address - Street 1:61325 29 PALMS HWY STE A
Mailing Address - Street 2:
Mailing Address - City:JOSHUA TREE
Mailing Address - State:CA
Mailing Address - Zip Code:92252-1912
Mailing Address - Country:US
Mailing Address - Phone:760-366-0420
Mailing Address - Fax:760-366-0520
Practice Address - Street 1:61325 29 PALMS HWY STE A
Practice Address - Street 2:
Practice Address - City:JOSHUA TREE
Practice Address - State:CA
Practice Address - Zip Code:92252-1912
Practice Address - Country:US
Practice Address - Phone:760-366-0420
Practice Address - Fax:760-366-0520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA547091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty