Provider Demographics
NPI:1205480605
Name:BAIK, YEU JIN (DDS)
Entity type:Individual
Prefix:DR
First Name:YEU JIN
Middle Name:
Last Name:BAIK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 CITY AVE APT A922
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-7702
Mailing Address - Country:US
Mailing Address - Phone:516-640-6812
Mailing Address - Fax:
Practice Address - Street 1:11060 SMILE WAY
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-3470
Practice Address - Country:US
Practice Address - Phone:540-775-7671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014166351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice