Healthcare Provider Details

I. General information

NPI: 1942400080
Provider Name (Legal Business Name): SHANWEN GAO LAC, OMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 S QUEBEC ST STE 200
CENTENNIAL CO
80111-4673
US

IV. Provider business mailing address

6500 S QUEBEC ST STE 200
CENTENNIAL CO
80111-4673
US

V. Phone/Fax

Practice location:
  • Phone: 303-221-0106
  • Fax: 303-221-0107
Mailing address:
  • Phone: 303-221-0106
  • Fax: 303-221-0107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: