Provider Demographics
NPI:1801957725
Name:BAEK, SEUNG HOON (DDS)
Entity type:Individual
Prefix:
First Name:SEUNG HOON
Middle Name:
Last Name:BAEK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5661 BEACH BLVD
Mailing Address - Street 2:STE.101
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-2045
Mailing Address - Country:US
Mailing Address - Phone:714-736-0100
Mailing Address - Fax:714-736-0101
Practice Address - Street 1:5661 BEACH BLVD
Practice Address - Street 2:STE.101
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-2045
Practice Address - Country:US
Practice Address - Phone:714-736-0100
Practice Address - Fax:714-736-0101
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA494651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice