Provider Demographics
NPI:1932768363
Name:GU, LISHA (DMD)
Entity type:Individual
Prefix:
First Name:LISHA
Middle Name:
Last Name:GU
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8707 PICKFORD ST APT 7
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-3430
Mailing Address - Country:US
Mailing Address - Phone:724-831-3138
Mailing Address - Fax:
Practice Address - Street 1:3663 W 6TH ST STE 205
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-3048
Practice Address - Country:US
Practice Address - Phone:213-388-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1061171223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics