Provider Demographics
NPI:1619181765
Name:LEE & BAE GI MEDICAL CORPORATION
Entity Type:Organization
Organization Name:LEE & BAE GI MEDICAL CORPORATION
Other - Org Name:WILSHIRE ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HO
Authorized Official - Middle Name:S
Authorized Official - Last Name:BAE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-739-9988
Mailing Address - Street 1:3200 WILSHIRE BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90010-1307
Mailing Address - Country:US
Mailing Address - Phone:213-739-9988
Mailing Address - Fax:213-739-0030
Practice Address - Street 1:3200 WILSHIRE BLVD STE 101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-1307
Practice Address - Country:US
Practice Address - Phone:213-739-9988
Practice Address - Fax:213-739-0030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051576Medicare PIN