Eunjoo Bae, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DN014224 Issued in GA

Practice address

3840 Peachtree Industrial Blvd
Suite 320
Duluth, GA 30096-5031

Phone

(770) 670-6555

NPI assigned

Mar 15, 2011

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Freedom 11, LLC

  • General Practice Dentistry
  • Duluth, GA
  • NPI 1215235726
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1300147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1300147200000",
    "number": "1104125202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3120 OAK HAMPTON WAY",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300965856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3840 PEACHTREE INDUSTRIAL BLVD",
            "address_2": "SUITE 320",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300965031",
            "telephone_number": "770-670-6555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAE",
        "first_name": "EUNJOO",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-03-15",
        "last_updated": "2011-03-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "DN014224",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Axis Wound Care, LLC
• Cindy Ayala
• Clement O Ayanbadejo
• Ayers Cares Group
• Ba Reun Health Center LLC
• Kyungtaek Baek, DMD
• Min Joo Baek, NP
• Rita G. Baens-Bailon, MD
• Caroline Bai, DO
• Jonathan Dean Bailey, PT, DPT

• Dentist in Duluth, GA
• Providers in Duluth, GA by specialty
• Dentist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.