Provider Demographics
NPI:1760551543
Name:DAVID GU, DO, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DAVID GU, DO, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:GUOQING
Authorized Official - Last Name:GU
Authorized Official - Suffix:
Authorized Official - Credentials:D O
Authorized Official - Phone:626-282-3999
Mailing Address - Street 1:723 S GARFIELD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4429
Mailing Address - Country:US
Mailing Address - Phone:626-282-3999
Mailing Address - Fax:626-282-8077
Practice Address - Street 1:723 S GARFIELD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4429
Practice Address - Country:US
Practice Address - Phone:626-282-3999
Practice Address - Fax:626-282-8077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A6851207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX68510Medicaid
CA00AX68510Medicaid