Ji Seon Bae
Individual provider Active NPI Family Nurse Practitioner · Carson, CA
NPI 1619390630 · NPPES record last updated Jan 27, 2014
Key facts
- NPI
- 1619390630
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 23263 (CA)
- Practice address
- 23517 Main St Ste 103
Carson, CA 90745-5234 - Phone
- (562) 889-8787
- NPI assigned
- Jan 27, 2014
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 23263 | CA | Yes |
Addresses
Primary practice location
23517 Main St Ste 103
Carson, CA 90745-5234
Mailing address
5830 Bonfair Ave
Lakewood, CA 90712-1120
Phone (562) 889-8787
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- Nancy M Bahem
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- Sharon Baker-Harris
- Cappie Baker
All providers in Carson, CA · Family Nurse Practitioner in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 27, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.