MEDICARE: DR. ALLEN KYUNGJIN BAE DMD

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	122300000X	Dentist	8001	NV

General Provider Information

NPI Number	:	1750065330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALLEN KYUNGJIN BAE DMD

Provider Business Mailing Address
First Line	:	6355 S DURANGO DR UNIT 1121
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-1798
Country	:	US
Telephone Number	:	714-944-2625
Fax Number	:

Provider Business Practice Location Address
First Line	:	5270 S FORT APACHE RD STE 350
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1724
Country	:	US
Telephone Number	:	702-273-3404
Fax Number	:

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

Provider Enumeration Date	:	06/14/2023
Last Update Date	:	09/13/2024

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