Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | A172827 | CA |
NPI | 1114454899 |
---|---|
Provider Name | Grace Yu Yi Gu |
First Address | Carson, CA 90745-5743 |
Second Address | Carson, CA 90745-5743 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/05/2017 |
Last Update Date | 03/12/2021 |