Provider Demographics
NPI:1447448048
Name:KEVIN GUO, MEDICAL PC
Entity type:Organization
Organization Name:KEVIN GUO, MEDICAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-966-8488
Mailing Address - Street 1:70 BOWERY
Mailing Address - Street 2:SUITE 308
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10013-4607
Mailing Address - Country:US
Mailing Address - Phone:212-966-8488
Mailing Address - Fax:
Practice Address - Street 1:70 BOWERY
Practice Address - Street 2:SUITE 308
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10013-4607
Practice Address - Country:US
Practice Address - Phone:212-966-8488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2015-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY221773207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYWEU171OtherMEDICARE GROUP NUMBER
NY02182332Medicaid
NY02182332Medicaid