Provider Demographics
NPI:1790572071
Name:GUO, XUTONG (MD)
Entity type:Individual
Prefix:DR
First Name:XUTONG
Middle Name:
Last Name:GUO
Suffix:
Gender:
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:GUANG BO ST
Mailing Address - Street 2:WAN GUO CHENG MOMA BUIDLING 3 ROOM 801
Mailing Address - City:TAIYUAN
Mailing Address - State:SHAN XI
Mailing Address - Zip Code:030000
Mailing Address - Country:CN
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:225 WILLIAMSON ST
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-3625
Practice Address - Country:US
Practice Address - Phone:908-994-5000
Practice Address - Fax:908-994-5000
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA$$$$$$$$$207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine