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General NPI Number Information
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NPI Number | 1437970852
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Entity Type | Individual
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Provider Name | SHAN GAO
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Gender | Female
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Dates
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Enumeration Date | 10/18/2024
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Last Update Date | 10/18/2024
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Provider Practice Location Address
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Address Line | 1941 OFARRELL ST STE 103
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City | SAN MATEO
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State | CA
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Zip | 94403-1374
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Country | US
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Telephone | 510-813-8336
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Fax |
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Provider Business Mailing Address
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Address Line | 4348 SATINWOOD DR
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City | CONCORD
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State | CA
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Zip | 94521-1305
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Country | US
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Telephone | 510-813-8336
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | NP95032385
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License Number State | CA
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