Provider Demographics
NPI:1497071500
Name:GUO, JIAN AN
Entity Type:Individual
Prefix:
First Name:JIAN AN
Middle Name:
Last Name:GUO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 EL CAMINO REAL
Mailing Address - Street 2:SUITE 103
Mailing Address - City:BELMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94002-2155
Mailing Address - Country:US
Mailing Address - Phone:650-620-9888
Mailing Address - Fax:650-472-8055
Practice Address - Street 1:490 EL CAMINO REAL
Practice Address - Street 2:SUITE 103
Practice Address - City:BELMONT
Practice Address - State:CA
Practice Address - Zip Code:94002-2155
Practice Address - Country:US
Practice Address - Phone:650-620-9888
Practice Address - Fax:650-472-8055
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12343171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12343OtherCALIFORNIA ACUPUNCTURE BOARD LICENSE