Provider Demographics
NPI:1467433326
Name:BAE, ROBERT J (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:J
Last Name:BAE
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1401 AVOCADO AVE
Mailing Address - Street 2:SUITE 602
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7720
Mailing Address - Country:US
Mailing Address - Phone:949-644-8722
Mailing Address - Fax:949-644-8893
Practice Address - Street 1:1401 AVOCADO AVE
Practice Address - Street 2:SUITE 602
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7720
Practice Address - Country:US
Practice Address - Phone:949-644-8722
Practice Address - Fax:949-644-8893
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2012-08-27
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Provider Licenses
StateLicense IDTaxonomies
CAA71046208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G59819Medicare UPIN
W17917Medicare UPIN
W17917Medicare PIN