Healthcare Provider Details

I. General information

NPI: 1457200602
Provider Name (Legal Business Name): GOGLO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2026
Last Update Date: 01/22/2026
Certification Date: 01/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111B S GOVERNORS AVE STE 90230
DOVER DE
19904-6903
US

IV. Provider business mailing address

1111B S GOVERNORS AVE STE 90230
DOVER DE
19904-6903
US

V. Phone/Fax

Practice location:
  • Phone: 469-915-5044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SHIGE YAMAJI
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 469-915-5044