Provider Demographics
NPI:1144385212
Name:BAEK, KELLY J (MD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:J
Last Name:BAEK
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Gender:F
Credentials:MD
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Mailing Address - Street 1:11818 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-6646
Mailing Address - Country:US
Mailing Address - Phone:310-828-4008
Mailing Address - Fax:310-828-3310
Practice Address - Street 1:11818 WILSHIRE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6646
Practice Address - Country:US
Practice Address - Phone:310-828-4008
Practice Address - Fax:310-828-3310
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2014-01-08
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA08120900207VE0102X
CAC53761207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology