Provider Demographics
NPI:1588956775
Name:BAE, BYUNG CHAN (RN)
Entity type:Individual
Prefix:MR
First Name:BYUNG
Middle Name:CHAN
Last Name:BAE
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4142 ELBERTSON ST
Mailing Address - Street 2:APT. 302
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1620
Mailing Address - Country:US
Mailing Address - Phone:610-507-2451
Mailing Address - Fax:
Practice Address - Street 1:4142 ELBERTSON ST
Practice Address - Street 2:APT. 302
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-1620
Practice Address - Country:US
Practice Address - Phone:610-507-2451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-06
Last Update Date:2011-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY641728-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse