Provider Demographics
NPI:1043476393
Name:BAY AREA HOSPITAL PHYSICIAN
Entity type:Organization
Organization Name:BAY AREA HOSPITAL PHYSICIAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TAM
Authorized Official - Middle Name:HOANG
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-258-5083
Mailing Address - Street 1:4945 PALEMETTO DUNES CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-2131
Mailing Address - Country:US
Mailing Address - Phone:408-772-7970
Mailing Address - Fax:
Practice Address - Street 1:200 JOSE FIGUERES AVE STE 180
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116
Practice Address - Country:US
Practice Address - Phone:408-258-5083
Practice Address - Fax:408-258-4347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-05
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9636207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A9636OtherLICENSE