Healthcare Provider Details

I. General information

NPI: 1740969591
Provider Name (Legal Business Name): BARON MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 01/20/2025
Certification Date: 01/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 WILSHIRE BLVD STE 207A
LOS ANGELES CA
90010-3233
US

IV. Provider business mailing address

3800 WILSHIRE BLVD STE 207A
LOS ANGELES CA
90010-3233
US

V. Phone/Fax

Practice location:
  • Phone: 213-985-7777
  • Fax: 213-900-1030
Mailing address:
  • Phone: 213-985-7777
  • Fax: 213-900-1030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DAESOON LEEM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 213-985-7777