Provider Demographics
NPI:1619931680
Name:BAE, YOUNG HOON (MD)
Entity Type:Individual
Prefix:MR
First Name:YOUNG
Middle Name:HOON
Last Name:BAE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14631 LEE HWY STE 214
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-5827
Mailing Address - Country:US
Mailing Address - Phone:703-830-1800
Mailing Address - Fax:703-830-1801
Practice Address - Street 1:14631 LEE HWY STE 214
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-5827
Practice Address - Country:US
Practice Address - Phone:703-830-1800
Practice Address - Fax:703-830-1801
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012367882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1000870001OtherDME PROVIDER
36489OtherCIGNA BEHAVIORAL HEALTH
VA10001138OtherOPTIMA
185720OtherANTHEM/BCBS
P00279999OtherRAILROAD MEDICARE
WV3810004019OtherWV MEDICAID
VA010233682Medicaid
O86926MOtherSENTARA
145899OtherVALUE OPTIONS
009156R55Medicare ID - Type Unspecified
O86926MOtherSENTARA
WV3810004019OtherWV MEDICAID
36489OtherCIGNA BEHAVIORAL HEALTH
P00279999OtherRAILROAD MEDICARE