JAE-O BAE (NPI# 1710196019) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710196019 |
| Entity Type | Individual |
| Full Name | JAE-O BAE |
| Credential | M.D. |
| Practice Address |
1919 E Thomas Rd Phoenix AZ 85016-7710 |
| Mailing Address |
3200 E Camelback Rd Ste 250 Phoenix AZ 85018-2327 |
| Practice Telephone | 6029330016 |
| Practice Fax Number | 6029334309 |
| Mailing Telephone | 6029331813 |
| Mailing Fax Number | 6029331820 |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2018-01-23 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2086S0120X |
Surgery Specialization: Pediatric Surgery |
42085 | AZ | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AZ | 430210 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1920 E Cambridge Ave, Suite #201, Phoenix, AZ 850061459 | 6022545561 | 6022542185 |
| Street Address |
1919 E THOMAS RD |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85016-7710 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538162953 | Richard N Southard | Pediatrics | 1919 E Thomas Rd, Phoenix, AZ 85016-7710 | 2005-05-31 |
| 1265049472 | Chelsea Agricola | Nurse Practitioner | 1919 E Thomas Rd, Phoenix, AZ 85016-7710 | 2020-09-30 |
| 1871109686 | Madeline Rose Mcnamee | Audiologist | 1919 E Thomas Rd, Phoenix, AZ 85016-7710 | 2020-09-17 |
| 1699380212 | Lindsey N Manz | Dietitian, Registered | 1919 E Thomas Rd, Phoenix, AZ 85016-7710 | 2020-09-10 |
| 1376156331 | Jena Paige Buck | Occupational Therapist | 1919 E Thomas Rd, Phoenix, AZ 85016-7710 | 2020-08-28 |
| 1386257244 | Alia Torfa | Registered Nurse | 1919 E Thomas Rd, Phoenix, AZ 85016-7710 | 2020-08-28 |
| 1336751999 | Cassandra E Martinez | Registered Nurse | 1919 E Thomas Rd, Phoenix, AZ 85016-7710 | 2020-08-17 |
| 1811508708 | Clara A Hart | Nurse Practitioner | 1919 E Thomas Rd, Phoenix, AZ 85016-7710 | 2020-08-13 |
| 1811505571 | Daniela M Giralt | Nurse Practitioner | 1919 E Thomas Rd, Phoenix, AZ 85016-7710 | 2020-07-20 |
| 1902424179 | Soren B Mickelsen | Speech-Language Pathologist | 1919 E Thomas Rd, Phoenix, AZ 85016-7710 | 2020-07-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851992705 | Heatheranne Baker-oldfield | Counselor | 2415 E Camelback Rd Ste 700, Phoenix, AZ 85016 | 2020-11-06 |
| 1780215681 | Sip Home Systems - Mesa LLC | Home Health | 24th At Camelback, 2375 E. Camelback Rd., Suite 600, Phoenix, AZ 85016 | 2020-01-29 |
| 1760945588 | Wei Wei | Student in an Organized Health Care Education/Training Program | Phoenix Children's Hospital 1919 E. Thomas Rd., Phoenix, AZ 85016 | 2019-04-09 |
| 1942765623 | Grace Hatfield | Dietitian, Registered | Phoenix Childrens Hospital 1919 E Thomas Rd, Phoenix, AZ 85016 | 2019-02-06 |
| 1861977027 | Dawn Yvette Lima | Occupational Therapy Assistant | 3128 E Cheery Ln, Phoenix, AZ 85016 | 2018-10-03 |
| 1720583685 | Kristin Pauline Hicklin | Registered Nurse | 2930 E Camelback Rd Ste 100, Phoenix, AZ 85016 | 2018-03-24 |
| 1588181622 | Taness Eyre Billington | Pharmacist | 1625 E. Camelback Rd., Phoenix, AZ 85016 | 2017-08-29 |
| 1093239048 | Emma Ross | Psychologist | 1919 E Thomas Rd Bldg 4th, Phoenix, AZ 85016 | 2017-08-01 |
| 1609396985 | Mohammed Waseemuddin | Student in an Organized Health Care Education/Training Program | Phoenix Children's Hospital, 1919 E Thomas Rd, Phoenix, AZ 85016 | 2017-06-27 |
| 1144777632 | Amanda Mazerall | Occupational Therapist | 4333 N 24th Street, Apartment 223, Phoenix, AZ 85016 | 2016-09-01 |
| Find all providers in zip 85016 | ||||
| Taxonomy Code | 2086S0120X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| Specialization | Pediatric Surgery |
| A surgeon with expertise in the management of surgical conditions in premature and newborn infants, children and adolescents. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659716983 | Cristine Sandra Velazco | Surgery | 1919 E Thomas Rd, Phoenix, AZ 85016-7710 | 2013-04-30 |
| 1639458201 | Benjamin Padilla | Surgery | 1919 E Thomas Rd, Phoenix, AZ 85016-7710 | 2011-08-12 |
| 1255621405 | Erin M Garvey | Surgery | 1919 E Thomas Rd, Phoenix, AZ 85016 | 2011-04-08 |
| 1558418590 | John Craig Egan | Surgery | 1920 E Cambridge Ave, # 201, Phoenix, AZ 85006 | 2007-01-04 |
| 1720190408 | Ramin Jamshidi | Surgery | 1920 E Cambridge Ave, Ste 201, Phoenix, AZ 85006-1459 | 2006-08-31 |
| 1780637231 | Daniel Jon Ostlie | Surgery | 1919 E Thomas Rd, Phoenix, AZ 85016-7710 | 2006-05-18 |
| 1063494326 | Michael Dimler | Surgery | 1920 E Cambridge Ave, 201, Phoenix, AZ 85006-1459 | 2005-11-14 |
| 1225010598 | Dorothy H. Rowe | Surgery | 1919 E Thomas Rd, Phoenix, AZ 85016-7710 | 2005-11-14 |
| 1568444826 | Leigh C. Mcgill | Surgery | 1920 E Cambridge Ave, 201, Phoenix, AZ 85006-1459 | 2005-11-14 |
| 1326020603 | David Morris Notrica | Surgery | 1919 E Thomas Rd, Phoenix, AZ 85016-7710 | 2005-11-14 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.