Provider Demographics
NPI:1992992143
Name:ROBERT J BAE MD A MEDICAL CORPORATION
Entity type:Organization
Organization Name:ROBERT J BAE MD A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:BAE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-644-8722
Mailing Address - Street 1:1401 AVOCADO AVE STE 602
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7715
Mailing Address - Country:US
Mailing Address - Phone:949-644-8722
Mailing Address - Fax:949-644-8893
Practice Address - Street 1:1401 AVOCADO AVE STE 602
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7715
Practice Address - Country:US
Practice Address - Phone:949-644-8722
Practice Address - Fax:949-644-8893
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71046208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G59819Medicare UPIN
W17917Medicare PIN