Provider Demographics
NPI:1326072349
Name:BAE, STEVE SANG-WOO (MD)
Entity type:Individual
Prefix:DR
First Name:STEVE
Middle Name:SANG-WOO
Last Name:BAE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 S RAYMOND AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-7142
Mailing Address - Country:US
Mailing Address - Phone:626-233-2853
Mailing Address - Fax:626-626-7773
Practice Address - Street 1:25 S RAYMOND AVE STE 110
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-7142
Practice Address - Country:US
Practice Address - Phone:626-233-2853
Practice Address - Fax:626-626-7773
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2024-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82405208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPENDINGMedicaid
PENDINGMedicare UPIN
CAPENDINGMedicaid