MEDICARE: YI GUO M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	TR 60459940	WA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207X00000X	Orthopaedic Surgery Physician	302063	NY

General Provider Information

NPI Number	:	1760893283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YI GUO M.D.

Provider Business Mailing Address
First Line	:	1250 WATERS PL
Second Line	:	TOWER 1, 11TH FLOOR
City	:	BRONX
State	:	NY
Zip	:	10461
Country	:	US
Telephone Number	:	347-577-4460
Fax Number	:

Provider Business Practice Location Address
First Line	:	1250 WATERS PL
Second Line	:	TOWER 1, 11TH FLOOR
City	:	BRONX
State	:	NY
Zip	:	10461-1046
Country	:	US
Telephone Number	:	718-920-2060
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2014
Last Update Date	:	07/08/2022

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