Provider Demographics
NPI:1154413524
Name:GANG BAO, M.D., INC.
Entity type:Organization
Organization Name:GANG BAO, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GANG
Authorized Official - Middle Name:
Authorized Official - Last Name:BAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-287-7617
Mailing Address - Street 1:6719 ALVARADO RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-5270
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83170207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20019Medicare PIN
CAL14550Medicare UPIN