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General NPI Number Information
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NPI Number | 1780179176
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Entity Type | Organization
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Legal Business Name | SUSAN BAE, DDS, MS, INC.
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Dates
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Enumeration Date | 06/27/2018
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Last Update Date | 07/13/2025
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Provider Practice Location Address
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Address Line | 10945 SOUTH ST STE 202A
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City | CERRITOS
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State | CA
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Zip | 90703-5366
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Country | US
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Telephone | 424-256-3967
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Fax |
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Provider Business Mailing Address
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Address Line | 325 N LARCHMONT BLVD STE 127
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City | LOS ANGELES
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State | CA
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Zip | 90004-3011
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. SUSAN BAE
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Credential |
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Telephone | 424-256-3967
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 100794
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License Number State | CA
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