Provider Demographics
NPI:1932145646
Name:BAI, DIANE Y (MD)
Entity Type:Individual
Prefix:
First Name:DIANE
Middle Name:Y
Last Name:BAI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 6TH AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4040
Mailing Address - Country:US
Mailing Address - Phone:253-272-8664
Mailing Address - Fax:253-627-7880
Practice Address - Street 1:1112 6TH AVE
Practice Address - Street 2:STE 200
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4040
Practice Address - Country:US
Practice Address - Phone:253-272-8664
Practice Address - Fax:253-627-7880
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00049108207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX186226001Medicaid
WA0298875OtherSTATE L&I
TX8F3157OtherBCBSTX
WA0298877OtherSTATE L&I
WA0298874OtherSTATE L&I
WA0298876OtherSTATE L&I
WA0298876OtherSTATE L&I
WA0298877OtherSTATE L&I
TX186226001Medicaid
TXP00328708Medicare PIN