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General NPI Number Information
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NPI Number | 1659689016
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Entity Type | Organization
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Legal Business Name | P.H. BAE, DDS,INC.
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Dates
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Enumeration Date | 09/20/2010
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Last Update Date | 10/02/2010
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Provider Practice Location Address
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Address Line | 3651 CRENSHAW BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90016-4849
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Country | US
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Telephone | 323-291-3900
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Fax |
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Provider Business Mailing Address
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Address Line | 3651 CRENSHAW BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90016-4849
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Country | US
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Telephone | 323-291-3900
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Fax |
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Authorized Official
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Title or Position | OWNER/ PRESIDENT
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Name | DR. PETER HYUN BAE
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Credential |
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Telephone | 323-291-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 50034
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License Number State | CA
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