Provider Demographics
NPI:1871604314
Name:BAIK, CHARLES CHULHO (DPM)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:CHULHO
Last Name:BAIK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:17400 IRVINE BLVD
Mailing Address - Street 2:SUITE H
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3030
Mailing Address - Country:US
Mailing Address - Phone:714-832-7212
Mailing Address - Fax:714-832-0554
Practice Address - Street 1:17400 IRVINE BLVD
Practice Address - Street 2:SUITE H
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3030
Practice Address - Country:US
Practice Address - Phone:714-832-7212
Practice Address - Fax:714-832-0554
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE4583213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E45830Medicaid
CAV06068Medicare UPIN
CA000E45830Medicaid