Provider Demographics
NPI:1689651135
Name:BAIK, KENNETH Y (MD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:Y
Last Name:BAIK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 E ARROW HWY
Mailing Address - Street 2:STE D
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-5525
Mailing Address - Country:US
Mailing Address - Phone:909-920-3753
Mailing Address - Fax:909-920-0875
Practice Address - Street 1:1175 E ARROW HWY
Practice Address - Street 2:STE D
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5525
Practice Address - Country:US
Practice Address - Phone:909-920-3753
Practice Address - Fax:909-920-0875
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC42999208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C429990Medicaid
CA00C429990Medicaid
C50205Medicare UPIN