Healthcare Provider Details

I. General information

NPI: 1932272192
Provider Name (Legal Business Name): MRS. KIOK BAE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2212 BLUERIDGE CT
FULLERTON CA
92831-1305
US

IV. Provider business mailing address

3400 W. LOMITA BLVD.
TORRANCE CA
90505-1305
US

V. Phone/Fax

Practice location:
  • Phone: 714-870-5569
  • Fax: 714-680-3675
Mailing address:
  • Phone: 310-530-3010
  • Fax: 310-530-7618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number45366
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: