Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | PO 3576 | FL |
NPI | 1093064529 |
---|---|
Provider Name | Dr. Sung-Ho Bae |
First Address | Miami, FL 33101-1347 |
Second Address | Miami, FL 33162-3607 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2012 |
Last Update Date | 11/06/2018 |