Healthcare Provider Details

I. General information

NPI: 1891978177
Provider Name (Legal Business Name): LEI GAO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2007
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16233 SYLVESTER RD SW STE 260
BURIEN WA
98166-3044
US

IV. Provider business mailing address

16233 SYLVESTER RD SW STE 260
BURIEN WA
98166-3044
US

V. Phone/Fax

Practice location:
  • Phone: 206-835-7400
  • Fax: 253-750-6100
Mailing address:
  • Phone: 206-835-7400
  • Fax: 253-750-6100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD.204536
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberMD60698217
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: