Provider Demographics
NPI:1669545125
Name:WAN, GUO ZHI (LAC)
Entity type:Individual
Prefix:DR
First Name:GUO
Middle Name:ZHI
Last Name:WAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11740 SAN PABLO AVE STE A
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-1786
Mailing Address - Country:US
Mailing Address - Phone:510-237-1680
Mailing Address - Fax:510-237-1619
Practice Address - Street 1:11740 SAN PABLO AVE STE A
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-1786
Practice Address - Country:US
Practice Address - Phone:510-237-1680
Practice Address - Fax:510-237-1619
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC5326171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist