Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | A115654 | CA |
NPI | 1124322086 |
---|---|
Provider Name | Dr. Guangqiang Gao |
First Address | Pomona, CA 91767-5900 |
Second Address | Pomona, CA 91767-3002 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2011 |
Last Update Date | 13/09/2018 |