Provider Demographics
NPI:1184798084
Name:BAK, SEUNGBUM
Entity type:Individual
Prefix:MR
First Name:SEUNGBUM
Middle Name:
Last Name:BAK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14535 VALLEY VIEW AVE STE L
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-5234
Mailing Address - Country:US
Mailing Address - Phone:562-802-0630
Mailing Address - Fax:562-802-0631
Practice Address - Street 1:14535 VALLEY VIEW AVE STE L
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-5234
Practice Address - Country:US
Practice Address - Phone:562-802-0630
Practice Address - Fax:562-802-0631
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies