Provider Demographics
NPI:1629783832
Name:BAE, HYUN-JIN
Entity Type:Individual
Prefix:
First Name:HYUN-JIN
Middle Name:
Last Name:BAE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52B E PALISADES BLVD
Mailing Address - Street 2:
Mailing Address - City:PALISADES PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07650-6736
Mailing Address - Country:US
Mailing Address - Phone:201-755-6321
Mailing Address - Fax:
Practice Address - Street 1:1 W 34TH ST # 402A
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3011
Practice Address - Country:US
Practice Address - Phone:646-725-4600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00152100171100000X
NY006881171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist