Provider Demographics
NPI:1740559780
Name:BAE, JACLYN (DDS)
Entity type:Individual
Prefix:DR
First Name:JACLYN
Middle Name:
Last Name:BAE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:JACLYN
Other - Middle Name:
Other - Last Name:HUI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:18652 CLUBHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-7057
Mailing Address - Country:US
Mailing Address - Phone:646-831-1346
Mailing Address - Fax:
Practice Address - Street 1:20527 YORBA LINDA BLVD
Practice Address - Street 2:
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-7109
Practice Address - Country:US
Practice Address - Phone:646-831-1346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-20
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA592901223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry