Healthcare Provider Details

I. General information

NPI: 1215595525
Provider Name (Legal Business Name): JASON ZHEN GU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2019
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 SCHOENERSVILLE RD
BETHLEHEM PA
18017-3574
US

IV. Provider business mailing address

2100 MACK BLVD FL 4
ALLENTOWN PA
18103-5622
US

V. Phone/Fax

Practice location:
  • Phone: 610-297-7500
  • Fax: 610-297-7533
Mailing address:
  • Phone: 484-884-0688
  • Fax: 484-884-0628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD480945
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: