# GAIA VIRTUAL MEDICINE. LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1730800475
- **Authorized official:** KEQIANG SHEN FNP (CEO)
- **Authorized official phone:** (480) 876-4013

## Contact information

- **Practice address:** 4494 W PEORIA AVE \#115A, SUITE 8, GLENDALE, AZ 85302
- **Practice address phone:** (602) 626-4473
- **Mailing address:** 28913 N 23RD DR, PHOENIX, AZ 85085-0715
- **Mailing address phone:** (602) 626-4473

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103T00000X | Psychologist | — | NULL | — |
| 103T00000X | Psychologist | — | — | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 253Z00000X | In Home Supportive Care Agency | — | NULL | — |

## Other

- **Enumeration date:** 09/12/2022
- **Last updated:** 05/20/2025