Provider Demographics
NPI:1831626423
Name:BAEK, SUJIN
Entity type:Individual
Prefix:
First Name:SUJIN
Middle Name:
Last Name:BAEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11275 E MISSISSIPPI AVE STE 1E8
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-2818
Mailing Address - Country:US
Mailing Address - Phone:303-955-1362
Mailing Address - Fax:303-647-3868
Practice Address - Street 1:11275 E MISSISSIPPI AVE STE 1E8
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-2818
Practice Address - Country:US
Practice Address - Phone:303-955-1362
Practice Address - Fax:303-647-3868
Is Sole Proprietor?:No
Enumeration Date:2017-05-15
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995805-NP363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care