Healthcare Provider Details

I. General information

NPI: 1457272957
Provider Name (Legal Business Name): YAO GAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 JEFFERSON AVE
ELIZABETH NJ
07201-2474
US

IV. Provider business mailing address

65 JEFFERSON AVE
ELIZABETH NJ
07201-2474
US

V. Phone/Fax

Practice location:
  • Phone: 908-469-9100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number22DI03168600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: