Healthcare Provider Details

I. General information

NPI: 1063214989
Provider Name (Legal Business Name): LILY GUO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2025
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 S BASCOM AVE
SAN JOSE CA
95128-2699
US

IV. Provider business mailing address

8899 UNIVERSITY CENTER LN STE 350
SAN DIEGO CA
92122-1010
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-5000
  • Fax: 408-885-6317
Mailing address:
  • Phone: 858-657-8322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA210350
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: