Provider Demographics
NPI:1447495031
Name:BAK, RACHEL DEENA (MD)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:DEENA
Last Name:BAK
Suffix:
Gender:F
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:201 S BUENA VISTA ST
Mailing Address - Street 2:STE. 420
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4571
Mailing Address - Country:US
Mailing Address - Phone:818-238-2350
Mailing Address - Fax:818-238-2351
Practice Address - Street 1:201 S BUENA VISTA ST
Practice Address - Street 2:STE. 420
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4571
Practice Address - Country:US
Practice Address - Phone:818-238-2350
Practice Address - Fax:818-238-2351
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2013-05-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA108217207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA108217OtherMEDICAL BOARD LICENSE