Provider Demographics
NPI:1871242719
Name:GUO, TIFFANY ZIYUAN
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:ZIYUAN
Last Name:GUO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14451 38TH AVE APT A
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5956
Mailing Address - Country:US
Mailing Address - Phone:646-203-6988
Mailing Address - Fax:
Practice Address - Street 1:14451 38TH AVE APT A
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5956
Practice Address - Country:US
Practice Address - Phone:646-203-6988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-19
Last Update Date:2022-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007094171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist