Provider Demographics
NPI:1891116166
Name:JIA GUO
Entity Type:Organization
Organization Name:JIA GUO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOM
Authorized Official - Prefix:
Authorized Official - First Name:JIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GUO
Authorized Official - Suffix:
Authorized Official - Credentials:DOM, LAC
Authorized Official - Phone:610-526-9598
Mailing Address - Street 1:26 SUMMIT GROVE AVE STE 26
Mailing Address - Street 2:
Mailing Address - City:BRYN MAWR
Mailing Address - State:PA
Mailing Address - Zip Code:19010-3230
Mailing Address - Country:US
Mailing Address - Phone:610-526-9598
Mailing Address - Fax:
Practice Address - Street 1:26 SUMMIT GROVE AVE STE 26
Practice Address - Street 2:
Practice Address - City:BRYN MAWR
Practice Address - State:PA
Practice Address - Zip Code:19010-3230
Practice Address - Country:US
Practice Address - Phone:610-526-9598
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOM 000017171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty