Provider Demographics
NPI:1285473983
Name:BAEK, ROBIN KYUNGHO
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:KYUNGHO
Last Name:BAEK
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 1:1713 10TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-5027
Mailing Address - Country:US
Mailing Address - Phone:575-439-5439
Mailing Address - Fax:
Practice Address - Street 1:1713 10TH ST STE A
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5027
Practice Address - Country:US
Practice Address - Phone:575-439-5439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDB-2024-01541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice