Provider Demographics
NPI:1487930376
Name:GUO, KEJING
Entity type:Individual
Prefix:DR
First Name:KEJING
Middle Name:
Last Name:GUO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2392 UNIVERSITY AVE
Mailing Address - Street 2:RIVERSIDE
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-4266
Mailing Address - Country:US
Mailing Address - Phone:949-302-4258
Mailing Address - Fax:
Practice Address - Street 1:2392 UNIVERSITY AVE
Practice Address - Street 2:RIVERSIDE
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-4266
Practice Address - Country:US
Practice Address - Phone:949-302-4258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60856183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist