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General NPI Number Information
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NPI Number | 1003397936
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Entity Type | Organization
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Legal Business Name | SHUANG BAI, M.D. INC.
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Dates
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Enumeration Date | 08/28/2018
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Last Update Date | 08/28/2018
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Provider Practice Location Address
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Address Line | 399 E HIGHLAND AVE STE 502
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City | SAN BERNARDINO
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State | CA
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Zip | 92404-3872
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Country | US
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Telephone | 909-883-3838
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Fax | 909-792-5531
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Provider Business Mailing Address
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Address Line | 399 E HIGHLAND AVE STE 502
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City | SAN BERNARDINO
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State | CA
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Zip | 92404-3872
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Country | US
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Telephone | 909-883-3838
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Fax | 909-792-5531
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MS. KELLI A BURNETT
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Credential |
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Telephone | 909-793-5511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A68895
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License Number State | CA
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