Provider Demographics
NPI:1760434542
Name:BAHNG, JOON H (MD)
Entity Type:Individual
Prefix:DR
First Name:JOON
Middle Name:H
Last Name:BAHNG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1125 E BROADWAY
Mailing Address - Street 2:71
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-1315
Mailing Address - Country:US
Mailing Address - Phone:818-240-8659
Mailing Address - Fax:818-242-8768
Practice Address - Street 1:801 S CHEVY CHASE DR.
Practice Address - Street 2:230
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1315
Practice Address - Country:US
Practice Address - Phone:818-240-8659
Practice Address - Fax:818-242-8768
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA22473207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A224730Medicaid
CAA23087Medicare UPIN
CAWA22473BMedicare ID - Type Unspecified