Provider Demographics
NPI:1013665538
Name:GUAN, DI (LAC)
Entity Type:Individual
Prefix:
First Name:DI
Middle Name:
Last Name:GUAN
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 1:9133 FOX RUN CIR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-2027
Mailing Address - Country:US
Mailing Address - Phone:612-380-7831
Mailing Address - Fax:
Practice Address - Street 1:807 BROADWAY ST NE STE 125
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-3701
Practice Address - Country:US
Practice Address - Phone:612-886-1125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1903171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist