Healthcare Provider Details

I. General information

NPI: 1346866811
Provider Name (Legal Business Name): JENNY GAO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 02/24/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

753 N 35TH ST STE 311
SEATTLE WA
98103-8873
US

IV. Provider business mailing address

620 N 34TH ST APT 404
SEATTLE WA
98103-8680
US

V. Phone/Fax

Practice location:
  • Phone: 408-888-4683
  • Fax:
Mailing address:
  • Phone: 408-888-4683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number61663934
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: