Provider Demographics
NPI:1982772240
Name:BAE, PETER HYUN (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:HYUN
Last Name:BAE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 W BADILLO ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-3762
Mailing Address - Country:US
Mailing Address - Phone:310-738-8020
Mailing Address - Fax:310-677-8009
Practice Address - Street 1:3530 W CENTURY BLVD
Practice Address - Street 2:SUITE # 107
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90303-1233
Practice Address - Country:US
Practice Address - Phone:310-677-8000
Practice Address - Fax:310-677-8009
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA500341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice