Healthcare Provider Details

I. General information

NPI: 1538375217
Provider Name (Legal Business Name): JIN GUO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 ANDERSON ST
LOMA LINDA CA
92354-2804
US

IV. Provider business mailing address

409 ALSTER AVE
ARCADIA CA
91006-4818
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-4094
  • Fax: 909-558-6425
Mailing address:
  • Phone: 909-558-4094
  • Fax: 909-558-6425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberA107121
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: