Provider Demographics
NPI:1790855351
Name:XU, JIANGUO (L AC)
Entity type:Individual
Prefix:MR
First Name:JIANGUO
Middle Name:
Last Name:XU
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3426 BROADWAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-5095
Mailing Address - Country:US
Mailing Address - Phone:425-359-2067
Mailing Address - Fax:425-673-4701
Practice Address - Street 1:3426 BROADWAY
Practice Address - Street 2:SUITE 101
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-5095
Practice Address - Country:US
Practice Address - Phone:425-359-2067
Practice Address - Fax:425-673-4701
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00000238171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist