Healthcare Provider Details

I. General information

NPI: 1699579185
Provider Name (Legal Business Name): JEFFREY WENJIE GU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2025
Last Update Date: 04/07/2025
Certification Date: 04/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVENUE, ROOM M798 PO BOX 0114, UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
SAN FRANCISCO CA
94143
US

IV. Provider business mailing address

505 PARNASSUS AVENUE, ROOM M798 PO BOX 0114, UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
SAN FRANCISCO CA
94143
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2273
  • Fax: 415-353-2898
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: