Provider Demographics
NPI:1669485140
Name:GUO, YAN WEN (LAC)
Entity Type:Individual
Prefix:
First Name:YAN
Middle Name:WEN
Last Name:GUO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95818-2001
Mailing Address - Country:US
Mailing Address - Phone:916-446-8147
Mailing Address - Fax:916-451-7328
Practice Address - Street 1:523 BROADWAY
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-2001
Practice Address - Country:US
Practice Address - Phone:916-446-8147
Practice Address - Fax:916-451-7328
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3821171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0038210Medicaid