Healthcare Provider Details

I. General information

NPI: 1659513836
Provider Name (Legal Business Name): HO S BAE M D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2009
Last Update Date: 03/03/2023
Certification Date: 03/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

520 S VIRGIL AVE #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

VIII. Authorized Official

Name: DR. HO SEOB BAE
Title or Position: PRESIDENT.
Credential: MD
Phone: 213-368-0360