Healthcare Provider Details

I. General information

NPI: 1912846080
Provider Name (Legal Business Name): YANQING GU, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 S APOLLO BLVD STE 103
MELBOURNE FL
32901-1274
US

IV. Provider business mailing address

551 S APOLLO BLVD STE 103
MELBOURNE FL
32901-1274
US

V. Phone/Fax

Practice location:
  • Phone: 321-984-2688
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. YANQING GU
Title or Position: OWNER
Credential: MD
Phone: 321-960-1764