Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | A130116 | CA |
NPI | 1003102856 |
---|---|
Provider Name | Dr. Jilin Bai |
First Address | Santa Clarita, CA 91355-3702 |
Second Address | Santa Clarita, CA 91355 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2011 |
Last Update Date | 13/07/2018 |