Provider Demographics
NPI:1386391043
Name:LO, GAOKIAB (PA-C)
Entity type:Individual
Prefix:
First Name:GAOKIAB
Middle Name:
Last Name:LO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5018 VISTA CT
Mailing Address - Street 2:
Mailing Address - City:MOHNTON
Mailing Address - State:PA
Mailing Address - Zip Code:19540-9011
Mailing Address - Country:US
Mailing Address - Phone:484-335-3126
Mailing Address - Fax:
Practice Address - Street 1:1703 INNOVATION DR STE 3136
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-8815
Practice Address - Country:US
Practice Address - Phone:717-741-3449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-03
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
PAMA063305363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical