Provider Demographics
NPI:1154420727
Name:GU, JIN (MD)
Entity type:Individual
Prefix:
First Name:JIN
Middle Name:
Last Name:GU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7505 OSLER DR
Mailing Address - Street 2:SUITE 312
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-7736
Mailing Address - Country:US
Mailing Address - Phone:410-828-8005
Mailing Address - Fax:410-828-0537
Practice Address - Street 1:7505 OSLER DR
Practice Address - Street 2:SUITE 312
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7736
Practice Address - Country:US
Practice Address - Phone:410-828-8005
Practice Address - Fax:410-828-0537
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD56623207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0001OtherBSDC
60924901OtherMPOS
7592182OtherANHM
004301000OtherMAMD
5004985OtherCGNA
81709OtherCOV
P00040271OtherMBRR
061656057OtherBSPA
08659000000OtherPHN
2504440OtherAHMO GROUP NUMBER
MD004301000Medicaid
0403724OtherUNHC
60924901OtherBSMD
061656057OtherCOMM
0928824OtherKEYS
2100369OtherMOPA
2504440OtherAHMO
7592182OtherANHM
MDH10402Medicare UPIN