Provider Demographics
NPI:1023251014
Name:BAE, YOON-SOO (BS, MA, MD)
Entity type:Individual
Prefix:DR
First Name:YOON-SOO
Middle Name:
Last Name:BAE
Suffix:
Gender:F
Credentials:BS, MA, MD
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:
Other - Last Name:BAE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS, MA, MD
Mailing Address - Street 1:317 E 34TH ST
Mailing Address - Street 2:11TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4974
Mailing Address - Country:US
Mailing Address - Phone:212-686-7306
Mailing Address - Fax:212-686-7305
Practice Address - Street 1:317 E 34TH ST
Practice Address - Street 2:11TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4974
Practice Address - Country:US
Practice Address - Phone:212-686-7306
Practice Address - Fax:212-686-7305
Is Sole Proprietor?:No
Enumeration Date:2009-04-07
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269401174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400088349Medicare UPIN