1154420727 NPI number — JIN GU MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154420727 NPI number — JIN GU MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

GU

Provider First Name:

JIN

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1154420727

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/21/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

7505 OSLER DR

Provider Second Line Business Mailing Address:

SUITE 312

Provider Business Mailing Address City Name:

TOWSON

Provider Business Mailing Address State Name:

MD

Provider Business Mailing Address Postal Code:

21204-7736

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

410-828-8005

Provider Business Mailing Address Fax Number:

410-828-0537

Provider First Line Business Practice Location Address:

7505 OSLER DR

Provider Second Line Business Practice Location Address:

SUITE 312

Provider Business Practice Location Address City Name:

TOWSON

Provider Business Practice Location Address State Name:

MD

Provider Business Practice Location Address Postal Code:

21204-7736

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

410-828-8005

Provider Business Practice Location Address Fax Number:

410-828-0537

Provider Enumeration Date:

09/21/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  D56623 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 0001 . This is a "BSDC" identifier . This identifiers is of the category "OTHER".
• Identifier: 60924901 . This is a "MPOS" identifier . This identifiers is of the category "OTHER".
• Identifier: 7592182 . This is a "ANHM" identifier . This identifiers is of the category "OTHER".
• Identifier: 004301000 . This is a "MAMD" identifier . This identifiers is of the category "OTHER".
• Identifier: 5004985 . This is a "CGNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 81709 . This is a "COV" identifier . This identifiers is of the category "OTHER".
• Identifier: P00040271 . This is a "MBRR" identifier . This identifiers is of the category "OTHER".
• Identifier: 061656057 . This is a "BSPA" identifier . This identifiers is of the category "OTHER".
• Identifier: 08659000000 . This is a "PHN" identifier . This identifiers is of the category "OTHER".
• Identifier: 2504440 . This is a "AHMO GROUP NUMBER" identifier . This identifiers is of the category "OTHER".
• Identifier: 004301000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
• Identifier: 0403724 . This is a "UNHC" identifier . This identifiers is of the category "OTHER".
• Identifier: 60924901 . This is a "BSMD" identifier . This identifiers is of the category "OTHER".
• Identifier: 061656057 . This is a "COMM" identifier . This identifiers is of the category "OTHER".
• Identifier: 0928824 . This is a "KEYS" identifier . This identifiers is of the category "OTHER".
• Identifier: 2100369 . This is a "MOPA" identifier . This identifiers is of the category "OTHER".
• Identifier: 2504440 . This is a "AHMO" identifier . This identifiers is of the category "OTHER".