Provider Demographics
NPI:1972996536
Name:GUO, KUANGHUA (MD, PHD)
Entity type:Individual
Prefix:
First Name:KUANGHUA
Middle Name:
Last Name:GUO
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3916 N FREMONT ST APT 3S
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-7370
Mailing Address - Country:US
Mailing Address - Phone:917-773-9943
Mailing Address - Fax:
Practice Address - Street 1:3324 N CLIFTON AVE APT 2F
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-2285
Practice Address - Country:US
Practice Address - Phone:917-773-9943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-06
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.078910207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine