Provider Demographics
NPI:1629968011
Name:BAE, KWANG MIN
Entity type:Individual
Prefix:
First Name:KWANG
Middle Name:MIN
Last Name:BAE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SAM
Other - Middle Name:
Other - Last Name:BAE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2609 NEVES CT
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-6511
Mailing Address - Country:US
Mailing Address - Phone:925-785-1681
Mailing Address - Fax:
Practice Address - Street 1:577 SALMAR AVE
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-1453
Practice Address - Country:US
Practice Address - Phone:669-242-5090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-07
Last Update Date:2025-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician