Provider Demographics
NPI:1962726174
Name:GAO, YI (LAC)
Entity type:Individual
Prefix:
First Name:YI
Middle Name:
Last Name:GAO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14812 PHYSICIANS LN
Mailing Address - Street 2:SUITE 261
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3943
Mailing Address - Country:US
Mailing Address - Phone:301-838-8559
Mailing Address - Fax:301-838-8529
Practice Address - Street 1:14812 PHYSICIANS LN
Practice Address - Street 2:SUITE 261
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3943
Practice Address - Country:US
Practice Address - Phone:301-838-8559
Practice Address - Fax:301-838-8529
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-16
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01807171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist