Provider Demographics
NPI:1235278490
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:JIA
Other - Middle Name:NADIA
Other - Last Name:GUO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOM, LAC
Mailing Address - Street 1:26 SUMMIT GROVE AVE
Mailing Address - Street 2:SUITE 26
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3230
Mailing Address - Country:US
Mailing Address - Phone:610-526-9598
Mailing Address - Fax:610-527-1599
Practice Address - Street 1:26 SUMMIT GROVE AVE
Practice Address - Street 2:SUITE 26
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3230
Practice Address - Country:US
Practice Address - Phone:610-526-9598
Practice Address - Fax:610-527-1599
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOM 000017171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist