Provider Demographics
NPI:1295907459
Name:BAE, YONG (LAC, PHD)
Entity type:Individual
Prefix:DR
First Name:YONG
Middle Name:
Last Name:BAE
Suffix:
Gender:M
Credentials:LAC, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3368 CABRILLO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-1502
Mailing Address - Country:US
Mailing Address - Phone:310-612-1914
Mailing Address - Fax:
Practice Address - Street 1:239 S LA CIENEGA BLVD
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3328
Practice Address - Country:US
Practice Address - Phone:310-657-8877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-27
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12253171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist