=====================================================
General NPI Number Information
=====================================================
NPI Number | 1386725919
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HELEN BAE CHIROPRACTIC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/18/2006
-----------------------------------------------------
Last Update Date | 06/24/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1790 HAMILTON AVE
-----------------------------------------------------
City | SAN JOSE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95125-5424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-381-3561
-----------------------------------------------------
Fax | 408-626-7365
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15550 ROCKFIELD BLVD B220
-----------------------------------------------------
City | IRVINE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92618-2720
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-598-9999
-----------------------------------------------------
Fax | 949-598-9990
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF CHIROPRACTIC
-----------------------------------------------------
Name | SOUNGYEON HELEN BAE
-----------------------------------------------------
Credential | D.C.
-----------------------------------------------------
Telephone | 510-381-3561
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 111N00000X
-----------------------------------------------------
Taxonomy Name | Chiropractor
-----------------------------------------------------
License Number | DC26180
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------