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General NPI Number Information
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NPI Number | 1841203528
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Entity Type | Individual
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Provider Name | YANQING GU MD
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Gender | Female
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 03/22/2019
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Provider Practice Location Address
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Address Line | 551 S APOLLO BLVD SUITE 103
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City | MELBOURNE
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State | FL
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Zip | 32901
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Country | US
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Telephone | 321-984-2688
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Fax | 321-984-2686
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Provider Business Mailing Address
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Address Line | 551 S APOLLO BLVD SUITE 103
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City | MELBOURNE
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State | FL
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Zip | 32901
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Country | US
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Telephone | 321-984-2688
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Fax | 321-984-2686
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME87769
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License Number State | FL
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