Basic Information
| Provider Information | |||||||||
| NPI: | 1932145646 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAI | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | Y | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1112 6TH AVE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984054040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532728664 | ||||||||
| FaxNumber: | 2536277880 | ||||||||
| Practice Location | |||||||||
| Address1: | 1112 6TH AVE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984054040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2532728664 | ||||||||
| FaxNumber: | 2536277880 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2006 | ||||||||
| LastUpdateDate: | 11/06/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | MD00049108 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 186226001 | 05 | TX | MEDICAID | 0298875 | 01 | WA | STATE L&I | OTHER | 8F3157 | 01 | TX | BCBSTX | OTHER | 0298877 | 01 | WA | STATE L&I | OTHER | 0298874 | 01 | WA | STATE L&I | OTHER | 0298876 | 01 | WA | STATE L&I | OTHER |