=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932272192
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. KIOK BAE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/16/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2212 BLUERIDGE CT
-----------------------------------------------------
City | FULLERTON
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92831-1305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 714-870-5569
-----------------------------------------------------
Fax | 714-680-3675
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3400 W. LOMITA BLVD.
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90505-1305
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-530-3010
-----------------------------------------------------
Fax | 310-530-7618
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | 45366
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------