Sejin Bae

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

22DI03014100 Issued in NJ

Practice address

100 North Academy Avenue
Danville, PA 17822

Phone

(570) 271-6211

NPI assigned

Apr 6, 2020

Sex

Male

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 NJ

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

Practice roles

Locations

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.

• Warren Oral & Maxillofacial Surgery Associates, LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Warren, NJ
  • NPI 1447548607
  Medicare reassignment NPD
• Warren Oral & Maxillofacial Surgery Center, LLC

  • Oral and Maxillofacial Surgery (Dentist)
  • Warren, NJ
  • NPI 1770749426
  NPD (past)

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

{
    "created_epoch": "1586131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722384000000",
    "number": "1528697109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9550 W SAHARA AVE UNIT 2063",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89117",
            "telephone_number": "714-980-1783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NORTH ACADEMY AVENUE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "17822",
            "telephone_number": "570-271-6211"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAE",
        "first_name": "SEJIN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-06",
        "last_updated": "2024-07-31",
        "certification_date": "2024-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "NJ",
            "license": "22DI03014100",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Derek Bacco
• Brandon John Bachert
• Kristine Kay Bachman, MS, CGC
• Kristin Marie Badman, CRNP-AGNP
• Nathan David Badman, PA-C
• Michele B. Bafile-Sharrow, PA-C
• Christopher Ravi Bailey
• Karen A. Bailey, M.D.
• Oksana Bailiff, M.D.
• John Bak, CRNP

• Oral & Maxillofacial Surgery (D.M.D.) in Danville, PA
• Providers in Danville, PA by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2024; 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.