Active NPI
Kwang Soo Bae, DDS
- General Practice Dentistry
- South Orange, NJ
National Provider Identifier
1891967733
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DI019644
- Practice address
- 172 Irvington Avenue
Suite a
South Orange, NJ 07079 - Phone
- (973) 275-6260
- Fax
- (973) 275-6270
- NPI assigned
- Apr 1, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DI019644 | NJ | Primary |
Addresses
Primary practice location
172 Irvington Avenue
Suite a
South Orange, NJ 07079
Mailing address
172 Irvington Avenue
Suite a
South Orange, NJ 07079
Phone (973) 275-6260
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 |
|---|---|---|---|
| DI019644 | NJ | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1207008000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1749600000000",
"number": "1891967733",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "172 IRVINGTON AVENUE",
"address_2": "SUITE A",
"city": "SOUTH ORANGE",
"state": "NJ",
"postal_code": "07079",
"telephone_number": "973-275-6260",
"fax_number": "973-275-6270"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "172 IRVINGTON AVENUE",
"address_2": "SUITE A",
"city": "SOUTH ORANGE",
"state": "NJ",
"postal_code": "07079",
"telephone_number": "973-275-6260",
"fax_number": "973-275-6270"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAE",
"first_name": "KWANG",
"middle_name": "SOO",
"name_prefix": "Mr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-04-01",
"last_updated": "2025-06-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "NJ",
"license": "DI019644",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Orange, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.