Healthcare Provider Details

I. General information

NPI: 1437340189
Provider Name (Legal Business Name): JIUPING GU DENTAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 LANDESS AVE
MILPITAS CA
95035-6953
US

IV. Provider business mailing address

1465 LANDESS AVE
MILPITAS CA
95035-6953
US

V. Phone/Fax

Practice location:
  • Phone: 408-946-0902
  • Fax:
Mailing address:
  • Phone: 408-946-0902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number42153
License Number StateCA

VIII. Authorized Official

Name: DR. JIUPING GU
Title or Position: CEO
Credential:
Phone: 408-946-0902