Provider Demographics
NPI:1821048257
Name:GU, MAI (MD)
Entity Type:Individual
Prefix:DR
First Name:MAI
Middle Name:
Last Name:GU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1810 FULLERTON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-3109
Mailing Address - Country:US
Mailing Address - Phone:951-808-8863
Mailing Address - Fax:951-808-0550
Practice Address - Street 1:1810 FULLERTON AVE STE 102
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-3109
Practice Address - Country:US
Practice Address - Phone:951-808-8863
Practice Address - Fax:951-808-0550
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA68810207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG98451Medicare UPIN