Individual
JAE GON BAE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4440 TWAIN AVE APT 277, SAN DIEGO, CA 92120-3478
(954) 393-9732
Mailing address
4440 TWAIN AVE APT 277, SAN DIEGO, CA 92120-3478
(954) 393-9732
Taxonomy
Speciality
Code
Description
License number
State
2471N0900X
Nuclear Medicine Technology Radiologic Technologist
CRT89082
FL
2471N0900X
Nuclear Medicine Technology Radiologic Technologist
Primary
RHN00004203
CA
Other
Enumeration date
02/12/2017
Last updated
04/06/2021
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