Healthcare Provider Details

I. General information

NPI: 1871866442
Provider Name (Legal Business Name): BAE OH AND TAKAHASHI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 02/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 S VIRGIL AVE STE 301
LOS ANGELES CA
90020-1404
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:
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 NumberA100119
License Number StateCA

VIII. Authorized Official

Name: DR. PILSOO OH
Title or Position: CEO
Credential: M.D.
Phone: 213-368-0360