Provider Demographics
NPI:1124476981
Name:BAIK, GASEON
Entity type:Individual
Prefix:
First Name:GASEON
Middle Name:
Last Name:BAIK
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 1:1352 IRVINE BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3549
Mailing Address - Country:US
Mailing Address - Phone:657-245-3357
Mailing Address - Fax:657-245-3297
Practice Address - Street 1:1352 IRVINE BLVD STE 105
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3549
Practice Address - Country:US
Practice Address - Phone:657-245-3357
Practice Address - Fax:657-245-3297
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 17039171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist