Provider Demographics
NPI:1922008598
Name:BAO, GANG (MD)
Entity Type:Individual
Prefix:DR
First Name:GANG
Middle Name:
Last Name:BAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6699 ALVARADO RD STE 2309
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5241
Mailing Address - Country:US
Mailing Address - Phone:619-286-8803
Mailing Address - Fax:619-286-2344
Practice Address - Street 1:6699 ALVARADO RD STE 2306
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5241
Practice Address - Country:US
Practice Address - Phone:619-287-7617
Practice Address - Fax:619-287-4536
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-26
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA83170207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAL14550Medicare UPIN
W-20019Medicare PIN