Provider Demographics
NPI:1134421571
Name:BAE, WON H (MD)
Entity type:Individual
Prefix:DR
First Name:WON
Middle Name:H
Last Name:BAE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2727 W OLYMPIC BLVD STE 304
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2699
Mailing Address - Country:US
Mailing Address - Phone:213-384-7555
Mailing Address - Fax:213-738-8798
Practice Address - Street 1:2727 W OLYMPIC BLVD STE 304
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2699
Practice Address - Country:US
Practice Address - Phone:213-384-7555
Practice Address - Fax:213-738-8798
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-17
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG83362208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery