Provider Demographics
NPI:1659389138
Name:BAYSIDE URGENT CARE AND FAMILY MEDICAL CLINIC P C
Entity Type:Organization
Organization Name:BAYSIDE URGENT CARE AND FAMILY MEDICAL CLINIC P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HAILING
Authorized Official - Middle Name:
Authorized Official - Last Name:FEI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-368-2888
Mailing Address - Street 1:39 BIRCH ST STE A
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-1483
Mailing Address - Country:US
Mailing Address - Phone:650-368-2888
Mailing Address - Fax:650-368-2878
Practice Address - Street 1:39 BIRCH ST STE A
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062
Practice Address - Country:US
Practice Address - Phone:650-368-2888
Practice Address - Fax:650-368-2878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78381207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ24112ZMedicaid
CAZZZ24112ZMedicaid