Provider Demographics
NPI:1891269320
Name:GAO, JING
Entity Type:Individual
Prefix:
First Name:JING
Middle Name:
Last Name:GAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17641 N 41ST ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-9241
Mailing Address - Country:US
Mailing Address - Phone:480-430-8610
Mailing Address - Fax:602-595-8664
Practice Address - Street 1:4550 E BELL RD STE 284
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-9384
Practice Address - Country:US
Practice Address - Phone:480-430-8610
Practice Address - Fax:602-595-8664
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-17
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-00428P225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist