Individual
SAM SEOHO BAE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., D.D.S.
Contact information
Practice address
6464 SW BORLAND RD STE D3, TUALATIN, OR 97062
(503) 692-5654
Mailing address
6464 SW BORLAND RD STE D3, TUALATIN, OR 97062-8861
(503) 692-5654
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
2901020742
MI
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
33845
TX
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
4301109828
MI
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
MD191912
OR
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
R6146
TX
Other
Enumeration date
06/19/2012
Last updated
06/29/2019
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