Provider Demographics
NPI:1295765378
Name:BAE, KUNIL (MD)
Entity type:Individual
Prefix:DR
First Name:KUNIL
Middle Name:
Last Name:BAE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15408 NORTHERN BLVD
Mailing Address - Street 2:STE 2I
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5042
Mailing Address - Country:US
Mailing Address - Phone:718-815-5175
Mailing Address - Fax:718-815-8681
Practice Address - Street 1:15408 NORTHERN BLVD
Practice Address - Street 2:STE 2I
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5042
Practice Address - Country:US
Practice Address - Phone:718-815-5175
Practice Address - Fax:718-815-8681
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY201190207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01663258Medicaid
NY01663258Medicaid
NYG27858Medicare UPIN
NY461632Medicare PIN