Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Y00000X | Otolaryngologist (ENT Doctor) | 016720 | CT |
N | 207YS0123X | Facial Plastic Surgeon | 016720 | CT |
NPI | 1881681609 |
---|---|
Provider Name | Jeune G Bae |
First Address | Bristol, CT 06011-2828 |
Second Address | Bristol, CT 06010-6379 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D78496 | (02) |