MEDICARE: BAE LIM DENTAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	50034	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467878918
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BAE LIM DENTAL CORPORATION

Provider Business Mailing Address
First Line	:	906 N VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-3519
Country	:	US
Telephone Number	:	323-913-0053
Fax Number	:

Provider Business Practice Location Address
First Line	:	906 N VERMONT AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-3519
Country	:	US
Telephone Number	:	323-913-0053
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PETER H BAE
Credential	:	D.D.S.
Telephone Number	:	323-913-0053

Provider Enumeration Date	:	03/07/2014
Last Update Date	:	03/07/2014

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Directions to “BAE LIM DENTAL CORPORATION ” Practice Location

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