Provider Demographics
NPI:1437199304
Name:BAO, WEI W (MD)
Entity Type:Individual
Prefix:
First Name:WEI
Middle Name:W
Last Name:BAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:W
Other - Last Name:BAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:17595 ALMAHURST ST
Mailing Address - Street 2:STE 202
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91748-1799
Mailing Address - Country:US
Mailing Address - Phone:626-581-4990
Mailing Address - Fax:626-581-4011
Practice Address - Street 1:17595 ALMAHURST ST
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748-1779
Practice Address - Country:US
Practice Address - Phone:626-581-4990
Practice Address - Fax:626-581-4011
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66842207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A668420Medicaid
CAA66842AMedicare ID - Type Unspecified
CA00A668420Medicaid