Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 225X00000X | Occupational Therapist | 11604 | CA |
Y | 225XM0800X | Mental Health | 11604 | CA |
N | 225XP0200X | Occupational Therapist - Pediatrics | 11604 | CA |
NPI | 1316171614 |
---|---|
Provider Name | Dr. Soyoung Esther Bae |
First Address | Pasadena, CA 91107-5903 |
Second Address | Los Angeles, CA 90031-2803 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2009 |
Last Update Date | 26/02/2021 |