Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | A150572 | CA |
NPI | 1003265653 |
---|---|
Provider Name | Dr. Gordon Hyeonjin Bae |
First Address | Redwood City, CA 94063-3132 |
Second Address | Redwood City, CA 94063-3132 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2016 |
Last Update Date | 06/08/2020 |