Theresia Choi Bae, LICENSE PSYCHOLOGIS

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

33325 Issued in CA

Practice address

15350 Sherman Way Ste 200
Van Nuys, CA 91406-4458

Phone

(818) 267-1100

NPI assigned

May 16, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 5

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Special Service for Groups, Inc.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Van Nuys, CA
  • NPI 1710018841
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147737600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1657670400000",
    "number": "1093767204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15350 SHERMAN WAY STE 200",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914064458",
            "telephone_number": "818-267-1100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15350 SHERMAN WAY STE 200",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914064458",
            "telephone_number": "818-267-1100"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "520 So. Lafayette Pk. Pl. 3rd Floor",
            "address_purpose": "LOCATION",
            "city": "LA",
            "state": "CA",
            "postal_code": "90057",
            "country_code": "US",
            "telephone_number": "213-252-2100 x110",
            "fax_number": "213-383-3146",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2121 W Temple St",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900264915",
            "country_code": "US",
            "telephone_number": "213-385-5100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CHOI BAE",
        "first_name": "THERESIA",
        "credential": "LICENSE  PSYCHOLOGIS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-05-16",
        "last_updated": "2022-07-13",
        "certification_date": "2022-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS23286",
            "primary": false
        },
        {
            "code": "225400000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Practitioner",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225C00000X",
            "taxonomy_group": "",
            "desc": "Rehabilitation Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "33325",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chiropractic & Occupational Health Center
• Nikolay Chitchyan
• In Bo Cho, DDS
• Jae Sil Cho
• Lucien Chocron, DR., LMFT, PSY.D
• Cheong W Choi, MD
• Francine Uk Choi, MD
• Won Sik Choi
• Jane Hyun Chon
• Ilene Chong, D.C.

• Clinical Psychologist in Van Nuys, CA
• Providers in Van Nuys, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.