Provider Demographics
NPI:1801044045
Name:XIE, GUOHUA (LAC)
Entity Type:Individual
Prefix:
First Name:GUOHUA
Middle Name:
Last Name:XIE
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 1:2130 HUNTINGTON DR STE 214
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-4970
Mailing Address - Country:US
Mailing Address - Phone:626-710-2076
Mailing Address - Fax:
Practice Address - Street 1:2130 HUNTINGTON DR STE 214
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-4970
Practice Address - Country:US
Practice Address - Phone:626-710-2076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-29
Last Update Date:2011-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12207171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD6416164OtherCA DRIVER LICENSE NUMBER