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SAM SEOHO BAE M.D., D.D.S.
NPI 1124381629
Oral & Maxillofacial Surgery in Tualatin, OR

Active since June 19, 2012PECOS Enrolled
6464 SW BORLAND RD STE D3, TUALATIN, OR 97062(503) 692-5654 Get Directions Write a Review

NPPES record last updated: June 29, 2019. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Sam Seoho Bae M.d., D.d.s. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SAM SEOHO BAE M.D., D.D.S. (NPI 1124381629) is an individual oral & maxillofacial surgery provider in Tualatin, Oregon, licensed in Oregon (MD191912) and active in the NPI registry since June 2012. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1124381629
Entity TypeIndividualMale
Primary Taxonomy204E00000X
Provider Legal NameSAM SEOHO BAECredential: M.D., D.D.S.
Location Address6464 SW BORLAND RD STE D3Tualatin, OR 97062
Mailing Address6464 Sw Borland Rd Ste D3Tualatin, OR 97062-8861 · (503) 692-5654
Phone(503) 692-5654
Sole ProprietorYes
Enumeration DateJune 19, 2012
Last NPPES UpdateJune 29, 2019
✔ NPI 1124381629 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOral & Maxillofacial SurgeryAllopathic & Osteopathic Physicians
Taxonomy Code204E00000X
Licenses✔ Licensed in OR · MD191912✔ Licensed in TX · 33845✔ Licensed in MI · 2901020742✔ Licensed in TX · R6146✔ Licensed in MI · 4301109828
Definition
Oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery.
6464 SW BORLAND RD STE D3, Tualatin, OR 97062
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Regence BlueCross BlueShield of Oregon.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Sam Seoho Bae M.d., D.d.s. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

THREE RIVERS ORAL AND FACIAL SURGERY LLC
Oral & Maxillofacial Surgery
6464 SW BORLAND RD STE D3
TUALATIN, OR 97062
Washington County (503) 692-5654
DANIEL PETRISOR DMD MD LLC
Dentist (Oral and Maxillofacial Surgery)
6464 SW BORLAND RD STE D3
TUALATIN, OR 97062
Washington County (214) 316-5743

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Sam Bae's NPI number?

The NPI number for Sam Bae is 1124381629. It was assigned to this individual provider in the NPPES registry on June 19, 2012.

Where is Sam Bae located?

Sam Bae practices at 6464 SW Borland Rd Ste D3, Tualatin, OR 97062. The listed phone number is (503) 692-5654.

What is Sam Bae's specialty?

The primary specialty registered for this NPI is Oral & Maxillofacial Surgery with taxonomy code 204E00000X.

Is Sam Bae enrolled in Medicare?

Yes. Sam Bae is registered in the Medicare PECOS enrollment system.

What insurance does Sam Bae accept?

Health plans from BridgeSpan Health Company and Regence BlueCross BlueShield of Oregon list Sam Bae as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Sam Bae was last updated on June 29, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.