Seong Gon Bae MD Inc

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

A123341 Issued in CA

Legal business name

SEONG GON BAE MD INC

Practice address

15211 Vanowen St Unit 200
Van Nuys, CA 91405-3606

Phone

(818) 782-3255

Fax

(818) 782-7026

NPI assigned

Nov 2, 2013

Organization subpart

No

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

Authorized official

Name

Seong Gon Bae, MD

Title

Ceo

Phone

(818) 782-3255

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1383350400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644451200000",
    "number": "1700215548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "230 S JACKSON ST APT 309",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912051592",
            "telephone_number": "818-782-3255",
            "fax_number": "818-782-7026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15211 VANOWEN ST UNIT 200",
            "city": "VAN NUYS",
            "state": "CA",
            "postal_code": "914053606",
            "telephone_number": "818-782-3255",
            "fax_number": "818-782-7026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SEONG GON BAE MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-02",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A",
        "authorized_official_last_name": "BAE",
        "authorized_official_first_name": "SEONG",
        "authorized_official_middle_name": "GON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "818-782-3255",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery",
            "state": "CA",
            "license": "A123341",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Surgery Physician in Van Nuys, CA
• Providers in Van Nuys, CA by specialty
• Surgery Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 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.