Provider Demographics
NPI:1144424102
Name:BAI, BRIAN C (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:C
Last Name:BAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 S C ST
Mailing Address - Street 2:STE A.,
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-5824
Mailing Address - Country:US
Mailing Address - Phone:805-247-1035
Mailing Address - Fax:805-247-1038
Practice Address - Street 1:331 S C ST
Practice Address - Street 2:STE A.,
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-5824
Practice Address - Country:US
Practice Address - Phone:805-247-1035
Practice Address - Fax:805-247-1038
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA101489207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7742839Medicaid
CA7742839Medicaid