Provider Demographics
NPI:1760760060
Name:GUAHAN PHYSICIANS AND CONSULTANTS
Entity Type:Organization
Organization Name:GUAHAN PHYSICIANS AND CONSULTANTS
Other - Org Name:LATTE STONE CANCER CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:671-777-3304
Mailing Address - Street 1:PO BOX 326723
Mailing Address - Street 2:
Mailing Address - City:HAGATNA
Mailing Address - State:GU
Mailing Address - Zip Code:96932-6012
Mailing Address - Country:US
Mailing Address - Phone:671-777-3304
Mailing Address - Fax:
Practice Address - Street 1:744 N MARINE CORPS DR STE C110
Practice Address - Street 2:
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-4426
Practice Address - Country:US
Practice Address - Phone:671-777-3305
Practice Address - Fax:671-647-0878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-03
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM-1656261QX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0200XAmbulatory Health Care FacilitiesClinic/CenterOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1184720807Medicare UPIN