Provider Demographics
NPI:1386859072
Name:GUAN, KAIXUAN
Entity Type:Individual
Prefix:
First Name:KAIXUAN
Middle Name:
Last Name:GUAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 STREET
Mailing Address - Street 2:920
Mailing Address - City:BROOKLYN NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:11228
Mailing Address - Country:US
Mailing Address - Phone:171-868-0593
Mailing Address - Fax:
Practice Address - Street 1:80 STREET
Practice Address - Street 2:920
Practice Address - City:BROOKLYN NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:11228
Practice Address - Country:US
Practice Address - Phone:718-680-5934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001722171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist