Provider Demographics
NPI:1982956991
Name:BAE, HYUN M (DDS)
Entity Type:Individual
Prefix:
First Name:HYUN
Middle Name:M
Last Name:BAE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 LECOMPTE ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-2437
Mailing Address - Country:US
Mailing Address - Phone:410-228-8770
Mailing Address - Fax:410-228-0598
Practice Address - Street 1:406 LECOMPTE ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-2437
Practice Address - Country:US
Practice Address - Phone:410-228-8770
Practice Address - Fax:410-228-0598
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15266122300000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC046728400Medicaid
MD072707500Medicaid