Healthcare Provider Details

I. General information

NPI: 1932768363
Provider Name (Legal Business Name): LISHA GU DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3663 W 6TH ST STE 205
LOS ANGELES CA
90020-3048
US

IV. Provider business mailing address

8707 PICKFORD ST APT 7
LOS ANGELES CA
90035-3430
US

V. Phone/Fax

Practice location:
  • Phone: 213-388-3636
  • Fax:
Mailing address:
  • Phone: 724-831-3138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License NumberDDS106117
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: