Provider Demographics
NPI:1891003257
Name:PETER HYUN BAE, DDS, INC.
Entity Type:Organization
Organization Name:PETER HYUN BAE, DDS, INC.
Other - Org Name:DR. BAE'S DENTAL PLAYGROUND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:H
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50034122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty