Provider Demographics
NPI:1669100582
Name:GUO, LUCY XUNYANG (DDS)
Entity type:Individual
Prefix:DR
First Name:LUCY
Middle Name:XUNYANG
Last Name:GUO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:XUNYANG
Other - Middle Name:
Other - Last Name:GUO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:12572 CAMINITO DE LA GALLARDA
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2376
Mailing Address - Country:US
Mailing Address - Phone:858-261-1829
Mailing Address - Fax:
Practice Address - Street 1:12572 CAMINITO DE LA GALLARDA
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2376
Practice Address - Country:US
Practice Address - Phone:858-261-1829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107693122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist