Provider Demographics
NPI:1033603600
Name:SHANGGUAN, XIAOFEI (LAC)
Entity Type:Individual
Prefix:
First Name:XIAOFEI
Middle Name:
Last Name:SHANGGUAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3893 LOST WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-4758
Mailing Address - Country:US
Mailing Address - Phone:513-884-0097
Mailing Address - Fax:888-847-1235
Practice Address - Street 1:5887 CORNELL RD
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-2026
Practice Address - Country:US
Practice Address - Phone:513-884-0097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-18
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.000351171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist