Healthcare Provider Details

I. General information

NPI: 1376422303
Provider Name (Legal Business Name): BAIOU MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2025
Last Update Date: 09/02/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1945 E. 17H ST #107
SANTA ANA CA
92705-6862
US

IV. Provider business mailing address

PO BOX 1012
SPRING VALLEY CA
91979-1012
US

V. Phone/Fax

Practice location:
  • Phone: 714-500-7714
  • Fax: 714-500-7713
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MOHAMED BAIOU
Title or Position: DIRECTOR / PRESIDENT
Credential: MD
Phone: 267-070-4577