Sang Bae, DDS
Dentist, General Practice in Bothell, WA. Individual provider (NPI-1).
NPI number1104147016
StatusActive
Last updated in NPPESJun 15, 2010
Details
- NPI
- 1104147016
- Entity type
- Individual (NPI-1)
- Name
- Sang Bae
- Credential
- DDS
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Jun 15, 2010
- Last updated
- Jun 15, 2010
Medicare and OIG
- Medicare enrolled (PECOS)
- Not in the Medicare enrollment file
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | DE 60056965 | WA | Yes |
Practice location
1729 208th St Se#101
Bothell, WA 98012-7789
Phone 425-485-8885
Mailing address
13426 64th Ave WEdmonds, WA 98026-3246
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This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.
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