Provider Demographics
NPI:1508937806
Name:XU, GUANGLI (LICENSED ACUPUNCTURE)
Entity Type:Individual
Prefix:
First Name:GUANGLI
Middle Name:
Last Name:XU
Suffix:
Gender:M
Credentials:LICENSED ACUPUNCTURE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 WASHINGTON ST STE 104A
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-7130
Mailing Address - Country:US
Mailing Address - Phone:617-731-0504
Mailing Address - Fax:617-383-6540
Practice Address - Street 1:930 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-1274
Practice Address - Country:US
Practice Address - Phone:671-414-6800
Practice Address - Fax:617-414-6817
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA527171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA527OtherACUPUNCTURE LICENSE