Provider Demographics
NPI:1699370288
Name:XUE, GUIFANG (LAC, MSA, MSOM)
Entity Type:Individual
Prefix:
First Name:GUIFANG
Middle Name:
Last Name:XUE
Suffix:
Gender:F
Credentials:LAC, MSA, MSOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 N 25TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-5205
Mailing Address - Country:US
Mailing Address - Phone:585-485-9963
Mailing Address - Fax:
Practice Address - Street 1:11551 NUCKOLS RD STE N
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-5565
Practice Address - Country:US
Practice Address - Phone:585-485-9963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-01
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QH0100X, 171100000X
VA0121000962171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0121000962OtherLICENSE ACUPUNCTURIST
VAB64209857OtherDRIVER LICENSE