Provider Demographics
NPI:1700312071
Name:BAHK, KEY (LAC, DIPL OM)
Entity Type:Individual
Prefix:MR
First Name:KEY
Middle Name:
Last Name:BAHK
Suffix:
Gender:M
Credentials:LAC, DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 NORRIS CANYON TER APT D
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1488
Mailing Address - Country:US
Mailing Address - Phone:925-577-0288
Mailing Address - Fax:
Practice Address - Street 1:275 NORRIS CANYON TER APT D
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1488
Practice Address - Country:US
Practice Address - Phone:925-577-0288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17529171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist