Healthcare Provider Details

I. General information

NPI: 1407566961
Provider Name (Legal Business Name): EUGENE GU MD INC PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2022
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 TALBOT RD S STE 314
RENTON WA
98055-6238
US

IV. Provider business mailing address

4300 TALBOT RD S STE 314
RENTON WA
98055-6238
US

V. Phone/Fax

Practice location:
  • Phone: 425-255-4742
  • Fax:
Mailing address:
  • Phone: 425-728-0907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DR. EUGENE GU
Title or Position: CEO
Credential: MD
Phone: 425-728-0907