Provider Demographics
NPI:1891772208
Name:GUAN, DAVID HONGRONG (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:HONGRONG
Last Name:GUAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1814 MCCALLIE AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-3025
Mailing Address - Country:US
Mailing Address - Phone:423-208-9030
Mailing Address - Fax:800-875-1615
Practice Address - Street 1:1814 MCCALLIE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-3025
Practice Address - Country:US
Practice Address - Phone:423-208-9030
Practice Address - Fax:800-875-1815
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056561207RC0200X
WI3065207RC0200X, 207RP1001X
NH22557207RP1001X
TN35362207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1891772208Medicaid
H33346Medicare UPIN
TN3724673Medicare ID - Type UnspecifiedMEDICARE