MEDICARE: DR. YIXIONG GU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	49326	CA

General Provider Information

NPI Number	:	1972783066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YIXIONG GU

Provider Business Mailing Address
First Line	:	5546 N. ROSEMEAD BLVD SUITE #104
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5546 N. ROSEMEAD BLVD SUITE #104
Second Line	:
City	:	TEMPLE CITY
State	:	CA
Zip	:	91780
Country	:	US
Telephone Number	:	626-285-9808
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2007
Last Update Date	:	03/25/2014

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