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General NPI Number Information
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NPI Number | 1124021423
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Entity Type | Individual
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Provider Name | YOUNG C BAE M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/31/2005
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Last Update Date | 02/27/2009
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Provider Practice Location Address
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Address Line | 512 LAKEHURST RD
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City | TOMS RIVER
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State | NJ
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Zip | 08755-8021
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Country | US
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Telephone | 732-240-0053
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Fax | 732-240-9360
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Provider Business Mailing Address
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Address Line | PO BOX 1058
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City | TOMS RIVER
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State | NJ
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Zip | 08754-1058
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Country | US
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Telephone | 732-240-0053
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Fax | 732-240-9360
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 25MA07552800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | D0020114
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License Number State | MD
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