Provider Demographics
NPI:1922022219
Name:BAEK, SHARON SUNGHEE (DC, LAC)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:SUNGHEE
Last Name:BAEK
Suffix:
Gender:F
Credentials:DC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9681 GARDEN GROVE BLVD STE 101-102
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1541
Mailing Address - Country:US
Mailing Address - Phone:714-530-7001
Mailing Address - Fax:714-530-7261
Practice Address - Street 1:9681 GARDEN GROVE BLVD STE 101-102
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1541
Practice Address - Country:US
Practice Address - Phone:714-530-7001
Practice Address - Fax:714-530-7261
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22627111NX0800X, 111NR0200X, 111NN0400X
CADC 22627111NS0005X
CAAC14975171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
No111NS0005XChiropractic ProvidersChiropractorSports Physician
No111NR0200XChiropractic ProvidersChiropractorRadiology
No111NN0400XChiropractic ProvidersChiropractorNeurology
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC22627OtherCHIROPRACTOR
CAAC 14975OtherACUPUNCTURE
CADC22627OtherCHIROPRACTOR