MEDICARE: GANG BAO, M.D., INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	A83170	CA

General Provider Information

NPI Number	:	1154413524
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GANG BAO, M.D., INC.

Provider Business Mailing Address
First Line	:	6719 ALVARADO RD
Second Line	:	SUITE 108
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-5270
Country	:	US
Telephone Number	:	619-286-8803
Fax Number	:	619-286-2344

Provider Business Practice Location Address
First Line	:	6699 ALVARADO RD STE 2306
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92120-5241
Country	:	US
Telephone Number	:	619-287-7617
Fax Number	:	619-287-4536

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GANG BAO
Credential	:	MD
Telephone Number	:	619-287-7617

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	12/21/2018

Similar Medicare Providers

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Practice Location Address:

6699 ALVARADO RD STE 2306
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1124014923 — ANANTHRAM POTTIPATI REDDY M.D.
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1073596342 — DR. DAVID M CHANG M.D.
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6699 ALVARADO RD STE 2309
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92120-5241

Practice Phone: 619-286-8803
Practice Fax: 619-286-2344

1275571010 — DR. JESUS HERRERA LAO MD
Practice Location Address:

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Practice Location Address:

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1255430369 — ANTHONY J CUOMO MD INC
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1104925205 — MICHAEL LAWRENCE BUTERA M.D.
Practice Location Address:

6699 ALVARADO RD STE 2309
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Practice Fax: 619-286-2344

Directions to “GANG BAO, M.D., INC. ” Practice Location

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