Basic Information
| Provider Information | |||||||||
| NPI: | 1891978177 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | GAO | ||||||||
| FirstName: | LEI | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16233 SYLVESTER RD SW STE 260 | ||||||||
| Address2: | |||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981663044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2068357400 | ||||||||
| FaxNumber: | 2537506100 | ||||||||
| Practice Location | |||||||||
| Address1: | 16233 SYLVESTER RD SW STE 260 | ||||||||
| Address2: | |||||||||
| City: | BURIEN | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981663044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2068357400 | ||||||||
| FaxNumber: | 2537506100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/10/2007 | ||||||||
| LastUpdateDate: | 12/03/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | MD.204536 | LA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RC0000X | MD60698217 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
ID Information
| ID | Type | State | Issuer | Description | 2153471 | 05 | LA | MEDICAID | 03434392 | 05 | MS | MEDICAID | 2073365 | 05 | WA | MEDICAID |