MEDICARE: LEE & BAE GI MEDICAL CORPORATION

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	261QE0800X	Endoscopy Clinic/Center

General Provider Information

NPI Number	:	1619181765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEE & BAE GI MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	3200 WILSHIRE BLVD STE 101
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-1307
Country	:	US
Telephone Number	:	213-739-9988
Fax Number	:	213-739-0030

Provider Business Practice Location Address
First Line	:	3200 WILSHIRE BLVD STE 101
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-1307
Country	:	US
Telephone Number	:	213-739-9988
Fax Number	:	213-739-0030

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. HO S BAE
Credential	:	MD
Telephone Number	:	213-739-9988

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	05/12/2015

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