MEDICARE: DR. HO SEOB BAE M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	G83132	CA
2	207RI0008X	Hepatology Physician	G83132	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	352166127	OTHER		TAX ID

General Provider Information

NPI Number	:	1053337998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HO SEOB BAE M.D.

Provider Business Mailing Address
First Line	:	520 S VIRGIL AVE STE 202
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1425
Country	:	US
Telephone Number	:	213-368-0360
Fax Number	:	213-368-0976

Provider Business Practice Location Address
First Line	:	520 S VIRGIL AVE STE 202
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90020-1425
Country	:	US
Telephone Number	:	213-368-0360
Fax Number	:	213-368-0976

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	11/22/2022

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Directions to “ DR. HO SEOB BAE M.D.” Practice Location

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