Healthcare Provider Details

I. General information

NPI: 1982956991
Provider Name (Legal Business Name): HYUN M. BAE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2012
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 LECOMPTE ST
CAMBRIDGE MD
21613-2437
US

IV. Provider business mailing address

406 LECOMPTE ST
CAMBRIDGE MD
21613-2437
US

V. Phone/Fax

Practice location:
  • Phone: 410-228-8770
  • Fax: 410-228-0598
Mailing address:
  • Phone: 410-228-8770
  • Fax: 410-228-0598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number15266
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: