Provider Demographics
NPI:1942950142
Name:XU, GUANG (ACUPUNCTURIST)
Entity Type:Individual
Prefix:
First Name:GUANG
Middle Name:
Last Name:XU
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 IVY LEAF CT
Mailing Address - Street 2:
Mailing Address - City:BOYDS
Mailing Address - State:MD
Mailing Address - Zip Code:20841-4112
Mailing Address - Country:US
Mailing Address - Phone:240-643-8856
Mailing Address - Fax:301-263-3480
Practice Address - Street 1:2301 RESEARCH BLVD STE 216
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3293
Practice Address - Country:US
Practice Address - Phone:240-643-8856
Practice Address - Fax:301-263-3480
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02846171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty