Healthcare Provider Details

I. General information

NPI: 1730634908
Provider Name (Legal Business Name): DAVID GU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 09/06/2024
Certification Date: 09/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SERENO DR
VALLEJO CA
94589-2441
US

IV. Provider business mailing address

5914 JORDAN AVE
EL CERRITO CA
94530-1655
US

V. Phone/Fax

Practice location:
  • Phone: 707-651-1042
  • Fax:
Mailing address:
  • Phone: 314-973-1613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number125.076718
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA195736
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: