Healthcare Provider Details

I. General information

NPI: 1932183472
Provider Name (Legal Business Name): YI YI STEPHANIE GU M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE GU M.D.

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 01/06/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 30TH ST #320
OAKLAND CA
94609-3424
US

IV. Provider business mailing address

350 30TH ST #320
OAKLAND CA
94609-3424
US

V. Phone/Fax

Practice location:
  • Phone: 510-465-6700
  • Fax: 510-465-7765
Mailing address:
  • Phone: 510-465-6700
  • Fax: 510-465-7765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberA88414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: