Basic Information
| Provider Information | |||||||||
| NPI: | 1528220365 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GUO | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | X | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2150 MARBLE CLIFF OFFICE PARK STE B | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432151056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6146271640 | ||||||||
| FaxNumber: | 6142996054 | ||||||||
| Practice Location | |||||||||
| Address1: | 2150 MARBLE CLIFF OFFICE PARK STE B | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432151056 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6146271640 | ||||||||
| FaxNumber: | 6142996054 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2008 | ||||||||
| LastUpdateDate: | 02/28/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 35.123013 | OH | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | 4301096606 | MI | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 4301096606 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.