1811908817 NPI number — JIN GU MD PA

Table of content: (NPI 1811908817)

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".




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