Active NPI
Minkyung Bae
- Dentist
- Herndon, VA
National Provider Identifier
1891378931
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 0401417607
- Practice address
- 1094 Elden St
Herndon, VA 20170-3803 - Phone
- (703) 787-2273
- NPI assigned
- May 5, 2021
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Dentist | 122300000X | 0401417607 | VA | Primary |
Addresses
Primary practice location
1094 Elden St
Herndon, VA 20170-3803
Mailing address
1094 Elden St
Herndon, VA 20170-3803
Phone (847) 704-0741
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401417607 | VA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1620172800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1733702400000",
"number": "1891378931",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1094 ELDEN ST",
"city": "HERNDON",
"state": "VA",
"postal_code": "201703803",
"telephone_number": "847-704-0741"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1094 ELDEN ST",
"city": "HERNDON",
"state": "VA",
"postal_code": "201703803",
"telephone_number": "703-787-2273"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAE",
"first_name": "MINKYUNG",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-05-05",
"last_updated": "2024-12-09",
"certification_date": "2024-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VA",
"license": "0401417607",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Herndon, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.