Provider Demographics
NPI:1649682550
Name:GAO, DIXU (LAC)
Entity type:Individual
Prefix:
First Name:DIXU
Middle Name:
Last Name:GAO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 FT WASHINGTON AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1248
Mailing Address - Country:US
Mailing Address - Phone:212-927-8039
Mailing Address - Fax:
Practice Address - Street 1:251 FT WASHINGTON AVE
Practice Address - Street 2:STE 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-1248
Practice Address - Country:US
Practice Address - Phone:212-927-8039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001538171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001538OtherSTATE LICENSE - ACUPUNCTURE