1811908817 NPI number — JIN GU MD PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811908817 NPI number — JIN GU MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JIN GU MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

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 Information

NPI Number:
1811908817
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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's Practice Location Mailing Address

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:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GU
Authorized Official First Name:
JIN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER PRESIDENT
Authorized Official Telephone Number:
410-828-8005

Provider Taxonomy Codes

  • 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" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 60924901 . This is a "BSMD PIN #" identifier . This identifiers is of the category "OTHER".
  • Identifier: F376 . This is a "BSDC GROUP #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5004985 . This is a "CGNA PIN #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7592182 . This is a "ANHM GROUP #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 004301000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0928824 . This is a "KEYS GROUP #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2504440 . This is a "AHMO PIN #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2504440 . This is a "AHMO GROUP #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 928824 . This is a "BSPA GROUP #" identifier . This identifiers is of the category "OTHER".
  • Identifier: KEG4JI . This is a "BSMD GROUP #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7592182 . This is a "ANHM PIN #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 81709 . This is a "COV PIN #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0001 . This is a "BSDC PIN #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5004985 . This is a "CGNA GROUP #" identifier . This identifiers is of the category "OTHER".
  • Identifier: 81709 . This is a "COV GROUP #" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com