Basic Information
Provider Information
NPI: 1548422934
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GO
FirstName: WILLIAM
MiddleName: Y.
NamePrefix: DR.
NameSuffix:  
Credential: M.D., PH.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 9500 GILMAN DR # MC0726
Address2: UCSD SCHOOL OF MEDICINE
City: LA JOLLA
State: CA
PostalCode: 920935004
CountryCode: US
TelephoneNumber: 8588226583
FaxNumber: 8588226444
Practice Location
Address1: 200 W ARBOR DR
Address2: UCSD MEDICAL CENTER
City: SAN DIEGO
State: CA
PostalCode: 921039001
CountryCode: US
TelephoneNumber: 8883098273
FaxNumber: 6195433183
Other Information
ProviderEnumerationDate: 06/27/2008
LastUpdateDate: 06/27/2008
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000XA101688CAN Allopathic & Osteopathic PhysiciansInternal Medicine 
207RH0003XA101688CAY Allopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology

No ID Information.


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