Provider Demographics
NPI:1205928694
Name:GUO, KEVIN J (MD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:GUO
Suffix:
Gender:M
Credentials:MD
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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:212-966-8467
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:212-966-8467
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2015-04-10
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Provider Licenses
StateLicense IDTaxonomies
NY221773207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02182332Medicaid
NYH54621Medicare UPIN
NY02182332Medicaid