Provider Demographics
NPI:1891978177
Name:GAO, LEI (MD)
Entity Type:Individual
Prefix:
First Name:LEI
Middle Name:
Last Name:GAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16233 SYLVESTER RD SW STE 260
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-3044
Mailing Address - Country:US
Mailing Address - Phone:206-835-7400
Mailing Address - Fax:253-750-6100
Practice Address - Street 1:16233 SYLVESTER RD SW STE 260
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3044
Practice Address - Country:US
Practice Address - Phone:206-835-7400
Practice Address - Fax:253-750-6100
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.204536207RC0000X
390200000X
WAMD60698217207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2153471Medicaid
MS03434392Medicaid
WA2073365Medicaid
LA4Q2667061Medicare PIN