Provider Demographics
NPI:1427647080
Name:BAE, HEEJIN JANE (LAC)
Entity type:Individual
Prefix:
First Name:HEEJIN
Middle Name:JANE
Last Name:BAE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:BAE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:118 W 72ND ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-3316
Mailing Address - Country:US
Mailing Address - Phone:646-655-9873
Mailing Address - Fax:
Practice Address - Street 1:118 W 72ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3316
Practice Address - Country:US
Practice Address - Phone:646-655-9873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-18
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006026-01171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty