Provider Demographics
NPI:1598975302
Name:GAO, DAVID (LAC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GAO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 S GARFIELD AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-2906
Mailing Address - Country:US
Mailing Address - Phone:626-569-0168
Mailing Address - Fax:626-569-0118
Practice Address - Street 1:240 S GARFIELD AVE STE B
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-2906
Practice Address - Country:US
Practice Address - Phone:626-569-0168
Practice Address - Fax:626-569-0118
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC7009171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist