Provider Demographics
NPI:1477585867
Name:GAO, RUISHAN (L AC)
Entity Type:Individual
Prefix:MRS
First Name:RUISHAN
Middle Name:
Last Name:GAO
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12925 POMERADO RD STE F
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-5356
Mailing Address - Country:US
Mailing Address - Phone:858-391-2746
Mailing Address - Fax:858-391-2746
Practice Address - Street 1:12925 POMERADO RD STE F
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-5356
Practice Address - Country:US
Practice Address - Phone:858-391-2746
Practice Address - Fax:858-391-2746
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6697171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist