Provider Demographics
NPI:1326592288
Name:GAI, FANGZHOU
Entity Type:Individual
Prefix:
First Name:FANGZHOU
Middle Name:
Last Name:GAI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 KAYE VUE DR APT 3E
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-2385
Mailing Address - Country:US
Mailing Address - Phone:203-540-7195
Mailing Address - Fax:
Practice Address - Street 1:173 OAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-2141
Practice Address - Country:US
Practice Address - Phone:860-503-3676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT676171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist