Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 40206 | CA |
N | 213EG0000X | General Practice | 40206 | CA |
N | 1223P0700X | Prosthodontist | 40206 | CA |
NPI | 1194946335 |
---|---|
Provider Name | Dr. Peter S Bae |
First Address | Bakersfield, CA 93309 |
Second Address | Bakersfield, CA 93309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2007 |
Last Update Date | 08/07/2007 |