Provider Demographics
NPI:1346211372
Name:BAE, SHARON JENNY (MD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:JENNY
Last Name:BAE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHARON
Other - Middle Name:JENNY
Other - Last Name:BAE-CHENG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1401 AVOCADO AVE
Mailing Address - Street 2:SUITE 710
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7720
Mailing Address - Country:US
Mailing Address - Phone:949-717-6755
Mailing Address - Fax:949-717-6859
Practice Address - Street 1:1401 AVOCADO AVE
Practice Address - Street 2:SUITE 710
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7720
Practice Address - Country:US
Practice Address - Phone:949-717-6755
Practice Address - Fax:949-717-6859
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-28
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA55097207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG53141Medicare UPIN