Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204E00000X | Oral & Maxillofacial Surgeon | DS041737 | PA |
N | 208200000X | Surgeon | MT224239 | PA |
N | 208600000X | Surgeon | MT224239 | PA |
NPI | 1104316074 |
---|---|
Provider Name | Dr. Jiasheng David Guo |
First Address | Pittsburgh, PA 15213-3410 |
Second Address | Pittsburgh, PA 15261-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2018 |
Last Update Date | 06/11/2021 |