Provider Demographics
NPI:1033555453
Name:GU, PAYAL KENIA (MD)
Entity Type:Individual
Prefix:
First Name:PAYAL
Middle Name:KENIA
Last Name:GU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PAYAL
Other - Middle Name:
Other - Last Name:KENIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4650 W SUNSET BLVD # 83
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-6062
Mailing Address - Country:US
Mailing Address - Phone:323-361-2101
Mailing Address - Fax:
Practice Address - Street 1:4650 W SUNSET BLVD # 83
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6062
Practice Address - Country:US
Practice Address - Phone:323-361-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-13
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301102609208000000X
CAA1557232084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics