Healthcare Provider Details

I. General information

NPI: 1245573187
Provider Name (Legal Business Name): JASON EUGENE BAHK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 03/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 16TH ST C2304
SANTA MONICA CA
90404-1249
US

IV. Provider business mailing address

1250 16TH ST C2304
SANTA MONICA CA
90404-1249
US

V. Phone/Fax

Practice location:
  • Phone: 310-319-4698
  • Fax:
Mailing address:
  • Phone: 310-319-4698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA134278
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: