Healthcare Provider Details

I. General information

NPI: 1538663919
Provider Name (Legal Business Name): HANS GAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4679 CALLE SAN JUAN
THOUSAND OAKS CA
91320-6776
US

IV. Provider business mailing address

4679 CALLE SAN JUAN
THOUSAND OAKS CA
91320-6776
US

V. Phone/Fax

Practice location:
  • Phone: 805-341-0714
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA166429
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: