Individual
JONATHAN GAO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11368 FAIRWIND CT, SAN DIEGO, CA 92130-8639
(858) 602-2422
Mailing address
11368 FAIRWIND CT, SAN DIEGO, CA 92130-8639
(858) 602-2422
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
105515
CA
Other
Enumeration date
05/11/2024
Last updated
05/11/2024
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