Provider Demographics
NPI:1972566222
Name:BAO, JOSEPH Y (M D)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:Y
Last Name:BAO
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13132 STUDEBAKER RD
Mailing Address - Street 2:SUITE 7A
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-2557
Mailing Address - Country:US
Mailing Address - Phone:562-868-3800
Mailing Address - Fax:562-868-3839
Practice Address - Street 1:13132 STUDEBAKER RD
Practice Address - Street 2:SUITE 7A
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-2557
Practice Address - Country:US
Practice Address - Phone:562-868-3800
Practice Address - Fax:562-868-3839
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53209204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAA532091Medicaid
CAA53209Medicare ID - Type UnspecifiedMEDICARE