Healthcare Provider Details

I. General information

NPI: 1053337998
Provider Name (Legal Business Name): HO SEOB BAE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 S VIRGIL AVE STE 202
LOS ANGELES CA
90020-1425
US

IV. Provider business mailing address

520 S VIRGIL AVE STE 202
LOS ANGELES CA
90020-1425
US

V. Phone/Fax

Practice location:
  • Phone: 213-368-0360
  • Fax: 213-368-0976
Mailing address:
  • Phone: 213-368-0360
  • Fax: 213-368-0976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberG83132
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberG83132
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: