Provider Demographics
NPI:1659591519
Name:BAE, YI K
Entity Type:Individual
Prefix:DR
First Name:YI
Middle Name:K
Last Name:BAE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11410 NE 19TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3030
Mailing Address - Country:US
Mailing Address - Phone:425-635-9414
Mailing Address - Fax:425-688-1657
Practice Address - Street 1:11410 NE 19TH ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3030
Practice Address - Country:US
Practice Address - Phone:425-635-9414
Practice Address - Fax:425-688-1657
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE8640122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist