Provider Demographics
NPI:1609827286
Name:BAI, LIQUN (MD)
Entity Type:Individual
Prefix:
First Name:LIQUN
Middle Name:
Last Name:BAI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6622 N 91ST AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-2569
Mailing Address - Country:US
Mailing Address - Phone:602-759-6883
Mailing Address - Fax:602-224-3358
Practice Address - Street 1:10615 W THUNDERBIRD BLVD STE C100
Practice Address - Street 2:
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3097
Practice Address - Country:US
Practice Address - Phone:623-974-1763
Practice Address - Fax:623-972-2038
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2019-08-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ33488207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ939100Medicaid
114765Medicare PIN
I34788Medicare UPIN