Provider Demographics
NPI:1124021886
Name:GU, GAOMAN (DDS, MSD, PHD)
Entity Type:Individual
Prefix:
First Name:GAOMAN
Middle Name:
Last Name:GU
Suffix:
Gender:F
Credentials:DDS, MSD, PHD
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:GU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1122 N 27TH PL
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-1471
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12610 DES MOINES MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98168-2284
Practice Address - Country:US
Practice Address - Phone:206-243-7788
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA000097541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice