Provider Demographics
NPI:1316202666
Name:BAE, SU AH (MD)
Entity Type:Individual
Prefix:DR
First Name:SU AH
Middle Name:
Last Name:BAE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20200 54TH AVE W
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-6389
Mailing Address - Country:US
Mailing Address - Phone:425-672-6400
Mailing Address - Fax:425-672-6518
Practice Address - Street 1:3520 SW 6TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-2806
Practice Address - Country:US
Practice Address - Phone:785-368-0445
Practice Address - Fax:785-354-0591
Is Sole Proprietor?:No
Enumeration Date:2012-07-11
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-38584207RE0101X
WAMD61137521207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS068002376OtherMEDICARE PTAN
KS201134630AMedicaid