Provider Demographics
NPI:1932202298
Name:GO, PETER KH (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER KH
Middle Name:
Last Name:GO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KONG HUA
Other - Middle Name:
Other - Last Name:GO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1757 ARMY DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:TAMUNING
Mailing Address - State:GU
Mailing Address - Zip Code:96913-1260
Mailing Address - Country:US
Mailing Address - Phone:671-647-4533
Mailing Address - Fax:671-647-1110
Practice Address - Street 1:1757 ARMY DR
Practice Address - Street 2:SUITE 106
Practice Address - City:TAMUNING
Practice Address - State:GU
Practice Address - Zip Code:96913-1260
Practice Address - Country:US
Practice Address - Phone:671-647-4533
Practice Address - Fax:671-647-1110
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GUM-1819174400000X, 173000000X
GUM1819208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
No173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR102107001Medicaid
FL004853500Medicaid
AR5F280Medicare ID - Type Unspecified
ARB90229Medicare UPIN
AR51931Medicare PIN
GUH107408Medicare PIN