Provider Demographics
NPI:1588811376
Name:JOSELYN BAILEY M D A MED CORP JOSELYN E BAILEY PRESIDENT
Entity Type:Organization
Organization Name:JOSELYN BAILEY M D A MED CORP JOSELYN E BAILEY PRESIDENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSELYN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-542-7341
Mailing Address - Street 1:4305 TORRANCE BL
Mailing Address - Street 2:SUITE 506
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4492
Mailing Address - Country:US
Mailing Address - Phone:310-542-7341
Mailing Address - Fax:310-542-7343
Practice Address - Street 1:4305 TORRANCE BL
Practice Address - Street 2:SUITE 506
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-4492
Practice Address - Country:US
Practice Address - Phone:310-542-7341
Practice Address - Fax:310-542-7343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-22
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC34767207R00000X, 207RN0300X
207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C347670Medicaid
CA1295843977OtherNPI
CAC34767Medicare PIN