Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 46359 | CA |
Y | 213EG0000X | General Practice | 46359 | CA |
NPI | 1003177155 |
---|---|
Provider Name | Dr. Sherry Baek |
First Address | La Mirada, CA 90638-6593 |
Second Address | Whittier, CA 90603-6593 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2012 |
Last Update Date | 04/10/2012 |