Provider Demographics
NPI:1790017515
Name:BAE, EUN-JIN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:EUN-JIN
Middle Name:
Last Name:BAE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 PEPPER TREE LN
Mailing Address - Street 2:APT 1216
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-5269
Mailing Address - Country:US
Mailing Address - Phone:703-732-1764
Mailing Address - Fax:
Practice Address - Street 1:900 PEPPER TREE LN
Practice Address - Street 2:APT 1216
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051-5269
Practice Address - Country:US
Practice Address - Phone:703-732-1764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-03
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63402183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist