Provider Demographics
NPI:1265112593
Name:BAE, KIYOUNG
Entity type:Individual
Prefix:
First Name:KIYOUNG
Middle Name:
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:GRAFENWOEHR TOWER BARRACKS BUILDING #475
Mailing Address - Street 2:
Mailing Address - City:GRAFENWOEHR
Mailing Address - State:MUCHEN
Mailing Address - Zip Code:92655
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:GRAFENWOEHR TOWER BARRACKS BUILDING #475
Practice Address - Street 2:
Practice Address - City:GRAFENWOEHR
Practice Address - State:MUCHEN
Practice Address - Zip Code:92655
Practice Address - Country:DE
Practice Address - Phone:657-465-2535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-21
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant