Provider Demographics
NPI:1427269257
Name:GUO, XIAOJUN (MD)
Entity type:Individual
Prefix:DR
First Name:XIAOJUN
Middle Name:
Last Name:GUO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 ARLEIGH RD
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1326
Mailing Address - Country:US
Mailing Address - Phone:718-749-4570
Mailing Address - Fax:
Practice Address - Street 1:13668 ROOSEVELT AVE UNIT 5D
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5510
Practice Address - Country:US
Practice Address - Phone:718-285-9688
Practice Address - Fax:718-887-2861
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM-13700207R00000X
WI50702208M00000X
MN62117208M00000X
NY250996208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03102238Medicaid
WI34935100Medicaid
27-1897588OtherTIN