Provider Demographics
NPI:1033309018
Name:GUO, JIA (DOM, LAC)
Entity Type:Individual
Prefix:
First Name:JIA
Middle Name:
Last Name:GUO
Suffix:
Gender:F
Credentials:DOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 LINDALE AVE
Mailing Address - Street 2:
Mailing Address - City:DREXEL HILL
Mailing Address - State:PA
Mailing Address - Zip Code:19026-3908
Mailing Address - Country:US
Mailing Address - Phone:610-628-9220
Mailing Address - Fax:610-628-9214
Practice Address - Street 1:4990 STATE RD
Practice Address - Street 2:STORE # 7
Practice Address - City:DREXEL HILL
Practice Address - State:PA
Practice Address - Zip Code:19026-4635
Practice Address - Country:US
Practice Address - Phone:610-628-9220
Practice Address - Fax:610-628-9214
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAKO000598171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist