Healthcare Provider Details

I. General information

NPI: 1518028711
Provider Name (Legal Business Name): SHISONG GUO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1929 IRVING ST. #201
SAN FRANCISCO CA
94122
US

IV. Provider business mailing address

1929 IRVING ST STE 201
SAN FRANCISCO CA
94122-1763
US

V. Phone/Fax

Practice location:
  • Phone: 415-564-2561
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZA2600X
TaxonomyMedical Art Specialist/Technologist
License NumberAC10817
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: