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General NPI Number Information
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NPI Number | 1619390630
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Entity Type | Individual
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Provider Name | JI SEON BAE
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Gender | Female
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Dates
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Enumeration Date | 01/27/2014
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Last Update Date | 01/27/2014
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Provider Practice Location Address
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Address Line | 23517 MAIN ST STE 103
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City | CARSON
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State | CA
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Zip | 90745-5234
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Country | US
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Telephone | 562-889-8787
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Fax |
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Provider Business Mailing Address
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Address Line | 5830 BONFAIR AVE
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City | LAKEWOOD
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State | CA
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Zip | 90712-1120
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Country | US
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Telephone | 562-889-8787
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 23263
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License Number State | CA
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