Active NPI
Kyoung Deok Baik, PHD
- Clinical Psychologist
- Fairfax, VA
National Provider Identifier
1558867333
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 0810005789
- Practice address
- 3554 Chain Bridge Rd Ste 103
Fairfax, VA 22030-2709 - Phone
- (703) 896-7628
- NPI assigned
- Apr 2, 2018
- Last updated
- Apr 2, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 0810005789 | VA | Primary |
Addresses
Primary practice location
3554 Chain Bridge Rd Ste 103
Fairfax, VA 22030-2709
Mailing address
6478 Wingate St
Alexandria, VA 22312-1643
Phone (419) 494-8904
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 13, 2024 through Feb 13, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0810005789 | VA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522627200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522627200000",
"number": "1558867333",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6478 WINGATE ST",
"city": "ALEXANDRIA",
"state": "VA",
"postal_code": "223121643",
"telephone_number": "419-494-8904"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3554 CHAIN BRIDGE RD STE 103",
"city": "FAIRFAX",
"state": "VA",
"postal_code": "220302709",
"telephone_number": "703-896-7628"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAIK",
"first_name": "KYOUNG DEOK",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-04-02",
"last_updated": "2018-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "VA",
"license": "0810005789",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfax, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.