Healthcare Provider Details

I. General information

NPI: 1912818634
Provider Name (Legal Business Name): SELINA GAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: YUE GAO

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 S COTTONWOOD ST
MURRAY UT
84107-5701
US

IV. Provider business mailing address

6657 S PLUMROSE WAY
TAYLORSVILLE UT
84123-6994
US

V. Phone/Fax

Practice location:
  • Phone: 801-507-6600
  • Fax:
Mailing address:
  • Phone: 385-528-4299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: