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NPI Code Detail

MEDICARE: DR. SOUNGWON BAE DO

MEDICARE: DR. SOUNGWON BAE DO
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
1208000000XPediatrics Physician3706AZ

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1922090513
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SOUNGWON BAE DO
Provider Business Mailing Address
First Line : PO BOX 31235
Second Line :
City : TUCSON
State : AZ
Zip : 85751-1235
Country : US
Telephone Number : 520-324-4100
Fax Number :
Provider Business Practice Location Address
First Line : 9348 E RITA RD STE 100
Second Line :
City : TUCSON
State : AZ
Zip : 85747-6313
Country : US
Telephone Number : 520-324-4760
Fax Number : 520-324-4759
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2005
Last Update Date : 06/13/2024

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Directions to “ DR. SOUNGWON BAE DO” Practice Location

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