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General NPI Number Information
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NPI Number | 1659513836
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Entity Type | Organization
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Legal Business Name | HO S BAE M D INC
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Dates
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Enumeration Date | 04/02/2009
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Last Update Date | 03/03/2023
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Provider Practice Location Address
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Address Line | 520 S VIRGIL AVE #202
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City | LOS ANGELES
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State | CA
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Zip | 90020-1425
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Country | US
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Telephone | 213-368-0360
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Fax | 213-368-0976
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Provider Business Mailing Address
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Address Line | 520 S VIRGIL AVE #202
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City | LOS ANGELES
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State | CA
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Zip | 90020-1425
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Country | US
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Telephone | 213-368-0360
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Fax | 213-368-0976
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Authorized Official
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Title or Position | PRESIDENT.
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Name | DR. HO SEOB BAE
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Credential | MD
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Telephone | 213-368-0360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | G83132
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License Number State | CA
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