Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NS0005X | Chiropractic Sports Physician | X009086 | NY |
NPI | 1265525828 |
---|---|
Provider Name | Hak-Soo Bae |
First Address | Flushing, NY 11354-2346 |
Second Address | Flushing, NY 11354-2346 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U73058 | (02) | NY |