Healthcare Provider Details

I. General information

NPI: 1023184603
Provider Name (Legal Business Name): DR. DONGHEE BAE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 N EUCLID ST
ANAHEIM CA
92801-3633
US

IV. Provider business mailing address

925 N EUCLID ST
ANAHEIM CA
92801-3633
US

V. Phone/Fax

Practice location:
  • Phone: 714-776-3457
  • Fax:
Mailing address:
  • Phone: 714-776-3457
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC6263
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: