MEDICARE: CHIBUM BAE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225100000X	Physical Therapist	39956	NY

General Provider Information

NPI Number	:	1013371087
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHIBUM BAE

Provider Business Mailing Address
First Line	:	3521 149TH ST
Second Line	:	3A
City	:	FLUSHING
State	:	NY
Zip	:	11354-3713
Country	:	US
Telephone Number	:	951-231-8800
Fax Number	:

Provider Business Practice Location Address
First Line	:	3521 149TH ST
Second Line	:	3A
City	:	FLUSHING
State	:	NY
Zip	:	11354-3713
Country	:	US
Telephone Number	:	951-231-8800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2016
Last Update Date	:	04/06/2016

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Directions to “ CHIBUM BAE ” Practice Location

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