Provider Demographics
NPI:1821353970
Name:BAO, DASHI (MD)
Entity type:Individual
Prefix:
First Name:DASHI
Middle Name:
Last Name:BAO
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 1:13620 MAPLE AVE # C901
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5166
Mailing Address - Country:US
Mailing Address - Phone:917-285-2780
Mailing Address - Fax:718-709-7589
Practice Address - Street 1:13620 MAPLE AVE # C901
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-5166
Practice Address - Country:US
Practice Address - Phone:917-285-2780
Practice Address - Fax:917-285-2776
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY265628207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03486642Medicaid
NY03486642Medicaid