Provider Demographics
NPI:1659810794
Name:GUO, RUN (LAC)
Entity Type:Individual
Prefix:
First Name:RUN
Middle Name:
Last Name:GUO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3930 COLLIS OAK CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-2473
Mailing Address - Country:US
Mailing Address - Phone:786-532-4722
Mailing Address - Fax:
Practice Address - Street 1:301 MAPLE AVE W STE 210
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-4301
Practice Address - Country:US
Practice Address - Phone:703-268-5558
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121-000840171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist