| Gaia Virtual Medicine. Llc | |
|
4494 W Peoria Ave #115a Suite 8 Glendale AZ 85302 | |
| (602) 626-4473 | |
| Not Available |
| Full Name | Gaia Virtual Medicine. Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 4494 W Peoria Ave #115a, Glendale, Arizona |
| Authorized Official Name and Position | Keqiang Shen (CEO) |
| Authorized Official Contact | 4808764013 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gaia Virtual Medicine. Llc 28913 N 23rd Dr Phoenix AZ 85085-0715 Ph: (602) 626-4473 | Gaia Virtual Medicine. Llc 4494 W Peoria Ave #115a Suite 8 Glendale AZ 85302 Ph: (602) 626-4473 |
| NPI Number | 1730800475 |
|---|---|
| Provider Enumeration Date | 09/12/2022 |
| Last Update Date | 05/20/2025 |
| Certification Date | 05/20/2025 |
| Medicare PECOS PAC ID | 0648632802 |
|---|---|
| Medicare Enrollment ID | O20230821000401 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730800475 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Secondary |
| 253Z00000X | In Home Supportive Care | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Ali Rajaei-tehrani |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1447337647 PECOS PAC ID: 9335140649 Enrollment ID: I20070129000343 |
| Provider Name | Keqiang Shen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154713048 PECOS PAC ID: 4082933742 Enrollment ID: I20150430000252 |
| Provider Name | Daniel Douglas Kiddy |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1144214529 PECOS PAC ID: 2567414030 Enrollment ID: I20180628002708 |
| Provider Name | Tiana T Wang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356181903 PECOS PAC ID: 2466993118 Enrollment ID: I20240920002259 |
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