Provider Demographics
NPI:1053356873
Name:GAO, JIANJUN (MD)
Entity type:Individual
Prefix:
First Name:JIANJUN
Middle Name:
Last Name:GAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 DRYDEN RD
Mailing Address - Street 2:3024
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1104
Mailing Address - Country:US
Mailing Address - Phone:832-452-9151
Mailing Address - Fax:
Practice Address - Street 1:1515 HOLCOMBE BLVD UNIT 1374
Practice Address - Street 2:U TEXAS MD ANDERSON CANCER CENTER, HEM/ONC DEPT
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4000
Practice Address - Country:US
Practice Address - Phone:713-792-2830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-17
Last Update Date:2014-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN9055207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX284687501Medicaid
TXTXB137346Medicare PIN