Healthcare Provider Details

I. General information

NPI: 1295907459
Provider Name (Legal Business Name): YONG BAE L.AC, PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 02/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 S LA CIENEGA BLVD
BEVERLY HILLS CA
90211-3328
US

IV. Provider business mailing address

3368 CABRILLO BLVD
LOS ANGELES CA
90066-1502
US

V. Phone/Fax

Practice location:
  • Phone: 310-657-8877
  • Fax:
Mailing address:
  • Phone: 310-612-1914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number12253
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: