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General NPI Number Information
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NPI Number | 1265112593
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Entity Type | Individual
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Provider Name | KIYOUNG BAE
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Gender | Male
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Dates
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Enumeration Date | 07/21/2023
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Last Update Date | 09/03/2026
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Provider Practice Location Address
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Address Line | AVIATION CLINIC, BDAACH, BUILDING 3030 4TH FLOOR
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City | CAMP HUMPHREYS, PYEONGTAEK
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State | GYEONGGI-DO
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Zip | 96273
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Country | KR
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Telephone | 657-465-2535
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Fax |
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Provider Business Mailing Address
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Address Line | PSC 400 BOX 5033
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City | APO
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State | AP
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Zip | 96273-0051
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Country | US
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Telephone | 657-465-2535
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Fax |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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