Provider Demographics
NPI:1972856185
Name:GAO, QIAN (RD)
Entity Type:Individual
Prefix:MS
First Name:QIAN
Middle Name:
Last Name:GAO
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 WITMER ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-2308
Mailing Address - Country:US
Mailing Address - Phone:213-977-2121
Mailing Address - Fax:
Practice Address - Street 1:616 WITMER ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-2308
Practice Address - Country:US
Practice Address - Phone:213-977-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-25
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered