Provider Demographics
NPI:1669104956
Name:BAEK, HYUNWOO ANDREW
Entity type:Individual
Prefix:
First Name:HYUNWOO
Middle Name:ANDREW
Last Name:BAEK
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 1:13220 JAMAICA AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:NY
Mailing Address - Zip Code:11418-2615
Mailing Address - Country:US
Mailing Address - Phone:716-800-8744
Mailing Address - Fax:718-427-9904
Practice Address - Street 1:13220 JAMAICA AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND HILL
Practice Address - State:NY
Practice Address - Zip Code:11418-2615
Practice Address - Country:US
Practice Address - Phone:716-800-8744
Practice Address - Fax:718-427-9904
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-27
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies