Provider Demographics
NPI:1386716579
Name:BAI, SAMMY SANG-JUNE (MD)
Entity type:Individual
Prefix:DR
First Name:SAMMY
Middle Name:SANG-JUNE
Last Name:BAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2486 5TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT LEE
Mailing Address - State:NJ
Mailing Address - Zip Code:07024-7840
Mailing Address - Country:US
Mailing Address - Phone:201-585-1179
Mailing Address - Fax:
Practice Address - Street 1:2486 5TH ST
Practice Address - Street 2:
Practice Address - City:FORT LEE
Practice Address - State:NJ
Practice Address - Zip Code:07024-7840
Practice Address - Country:US
Practice Address - Phone:201-585-1179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2009-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08147700207R00000X
CAA94957207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ142463Medicare PIN