=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730989492
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUNSHENG GUO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/13/2025
-----------------------------------------------------
Last Update Date | 03/13/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9945 LOWER AZUSA RD
-----------------------------------------------------
City | TEMPLE CITY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91780-4041
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-442-3400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7502 SHORTHORN ST
-----------------------------------------------------
City | CHINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91708-9111
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-220-1460
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2472R0900X
-----------------------------------------------------
Taxonomy Name | Renal Dialysis Technician
-----------------------------------------------------
License Number | 152297
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------