Provider Demographics
NPI:1881866234
Name:PETER H. BAE DDS. DENTAL CORPORATION
Entity Type:Organization
Organization Name:PETER H. BAE DDS. DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:HYUN
Authorized Official - Last Name:BAE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-294-8654
Mailing Address - Street 1:1810 W SLAUSON AVE STE J
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90047-1133
Mailing Address - Country:US
Mailing Address - Phone:323-294-8654
Mailing Address - Fax:323-294-8695
Practice Address - Street 1:1810 W SLAUSON AVE STE J
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90047-1133
Practice Address - Country:US
Practice Address - Phone:323-294-8654
Practice Address - Fax:323-294-8695
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PETER H. BAE DENTAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-26
Last Update Date:2008-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA500341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty