1619931680 NPI number — MR. YOUNG HOON BAE MD

Table of content: MR. YOUNG HOON BAE MD (NPI 1619931680)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619931680 NPI number — MR. YOUNG HOON BAE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAE
Provider First Name:
YOUNG
Provider Middle Name:
HOON
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619931680
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14631 ROUTE 29 STE 209
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CENTREVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20121-5827
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-830-1800
Provider Business Mailing Address Fax Number:
703-830-1801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14631 ROUTE 29 STE 209
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTREVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20121-5827
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-830-1800
Provider Business Practice Location Address Fax Number:
703-830-1801
Provider Enumeration Date:
04/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  0101236788 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 10001138 . This is a "OPTIMA" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 185720 . This is a "ANTHEM/BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3810004019 . This is a "WV MEDICAID" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 010233682 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 145899 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1000870001 . This is a "DME PROVIDER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 36489 . This is a "CIGNA BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00279999 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: O86926M . This is a "SENTARA" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com