Healthcare Provider Details

I. General information

NPI: 1326592288
Provider Name (Legal Business Name): FANGZHOU GAI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2016
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 RIDGE AVE
EVANSTON IL
60202-3328
US

IV. Provider business mailing address

8334 HARDING AVE
SKOKIE IL
60076-2713
US

V. Phone/Fax

Practice location:
  • Phone: 847-316-6283
  • Fax:
Mailing address:
  • Phone: 203-540-7195
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number070.027830
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number676
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: