Provider Demographics
NPI:1679871875
Name:BRIAN BAI CLINIC, INC
Entity type:Organization
Organization Name:BRIAN BAI CLINIC, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:BAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-485-7111
Mailing Address - Street 1:331 S C ST
Mailing Address - Street 2:STE A.,
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-5824
Mailing Address - Country:US
Mailing Address - Phone:805-247-1035
Mailing Address - Fax:805-247-1038
Practice Address - Street 1:331 S C ST
Practice Address - Street 2:STE A.,
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-5824
Practice Address - Country:US
Practice Address - Phone:805-247-1035
Practice Address - Fax:805-247-1038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-11
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101489207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7742839Medicaid
CA7742839Medicaid