Provider Demographics
NPI:1669958294
Name:SHI, XIN GUAN (ACUPUNCTURIST)
Entity type:Individual
Prefix:
First Name:XIN GUAN
Middle Name:
Last Name:SHI
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 S AZUSA AVE UNIT 533
Mailing Address - Street 2:
Mailing Address - City:CITY OF INDUSTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91748-1661
Mailing Address - Country:US
Mailing Address - Phone:626-378-8899
Mailing Address - Fax:
Practice Address - Street 1:1600 S AZUSA AVE UNIT 533
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748-1661
Practice Address - Country:US
Practice Address - Phone:626-378-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17998171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC17988OtherACUPUNCTURIST