Provider Demographics
NPI:1194898007
Name:BAE, VIVIAN HYUN JIN (DDS)
Entity type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:HYUN JIN
Last Name:BAE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16320 SE 66TH ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98006-5653
Mailing Address - Country:US
Mailing Address - Phone:425-747-7422
Mailing Address - Fax:
Practice Address - Street 1:20710 1ST AVE S
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-2849
Practice Address - Country:US
Practice Address - Phone:206-878-8180
Practice Address - Fax:206-878-5823
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE99841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice