Provider Demographics
NPI:1265784110
Name:GAO, XU (LAC)
Entity type:Individual
Prefix:MR
First Name:XU
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 1:23 RINI RD
Mailing Address - Street 2:
Mailing Address - City:GLEN HEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11545-2410
Mailing Address - Country:US
Mailing Address - Phone:917-362-3868
Mailing Address - Fax:
Practice Address - Street 1:13336 41ST RD STE 2B
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3666
Practice Address - Country:US
Practice Address - Phone:917-362-3868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004826171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist