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General NPI Number Information
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NPI Number | 1750065330
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Entity Type | Individual
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Provider Name | ALLEN KYUNGJIN BAE DMD
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Gender | Male
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Dates
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Enumeration Date | 06/14/2023
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 5270 S FORT APACHE RD STE 350
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City | LAS VEGAS
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State | NV
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Zip | 89148-1724
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Country | US
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Telephone | 702-273-3404
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Fax |
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Provider Business Mailing Address
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Address Line | 6355 S DURANGO DR UNIT 1121
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City | LAS VEGAS
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State | NV
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Zip | 89113-1798
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Country | US
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Telephone | 714-944-2625
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 8001
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License Number State | NV
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