Provider Demographics
NPI:1821783903
Name:BAY SENIOR MEDICAL HOUSE CLINIC PC
Entity Type:Organization
Organization Name:BAY SENIOR MEDICAL HOUSE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHUI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-417-8733
Mailing Address - Street 1:39899 BALENTINE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-5361
Mailing Address - Country:US
Mailing Address - Phone:510-417-8733
Mailing Address - Fax:
Practice Address - Street 1:34220 ANGUS COURT
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94555
Practice Address - Country:US
Practice Address - Phone:510-417-8733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-06
Last Update Date:2024-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center