Healthcare Provider Details

I. General information

NPI: 1417319609
Provider Name (Legal Business Name): JIA JUN GUAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 05/20/2023
Certification Date: 05/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 NEWHALL ST
SAN FRANCISCO CA
94124-1420
US

IV. Provider business mailing address

1 NEWHALL ST
SAN FRANCISCO CA
94124-1420
US

V. Phone/Fax

Practice location:
  • Phone: 415-641-3600
  • Fax:
Mailing address:
  • Phone: 415-641-3600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207ZF0201X
TaxonomyForensic Pathology Physician
License NumberA155359
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: