Provider Demographics
NPI:1982102034
Name:P HYUN BAE DENTAL CORPORATION
Entity type:Organization
Organization Name:P HYUN BAE DENTAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:HYUN
Authorized Official - Last Name:BAE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-738-8020
Mailing Address - Street 1:425 S IRVING BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-4725
Mailing Address - Country:US
Mailing Address - Phone:310-738-8020
Mailing Address - Fax:
Practice Address - Street 1:1637 E 103RD ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90002-2923
Practice Address - Country:US
Practice Address - Phone:323-563-3322
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-24
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA500341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty