Provider Demographics
NPI:1205028743
Name:GU, BO TAO
Entity Type:Individual
Prefix:
First Name:BO TAO
Middle Name:
Last Name:GU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10025 QUEENS BLVD
Mailing Address - Street 2:SUITE 1-P
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2454
Mailing Address - Country:US
Mailing Address - Phone:718-896-0909
Mailing Address - Fax:
Practice Address - Street 1:10025 QUEENS BLVD
Practice Address - Street 2:SUITE 1-P
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2454
Practice Address - Country:US
Practice Address - Phone:718-896-0909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-17
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000461171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist