Provider Demographics
NPI:1104276229
Name:BE, STEPHANIE MAI LAN (DO)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MAI LAN
Last Name:BE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8731 W PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2205
Mailing Address - Country:US
Mailing Address - Phone:310-312-5437
Mailing Address - Fax:
Practice Address - Street 1:8731 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-2205
Practice Address - Country:US
Practice Address - Phone:310-312-5437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-20
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY274346-443208000000X
CA20A18111208000000X
MA279591208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics