Individual
SUSAN BAE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10945 SOUTH ST STE 202A, CERRITOS, CA 90703-5366
(424) 256-3967
Mailing address
325 N LARCHMONT BLVD STE 127, LOS ANGELES, CA 90004-3011
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
100794
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100794
—
CA
Enumeration date
06/27/2018
Last updated
07/30/2024
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