Healthcare Provider Details

I. General information

NPI: 1639158124
Provider Name (Legal Business Name): YING GUO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 05/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 E 32ND ST 10TH FLOOR
NEW YORK NY
10016-6055
US

IV. Provider business mailing address

14275 MIDWAY RD SUITE 400
ADDISON TX
75001-3614
US

V. Phone/Fax

Practice location:
  • Phone: 800-553-6621
  • Fax: 212-889-8268
Mailing address:
  • Phone: 800-553-6621
  • Fax: 610-271-4245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License Number214881
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License Number214881
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: