Healthcare Provider Details

I. General information

NPI: 1174630800
Provider Name (Legal Business Name): GUO YING MAO LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ROGER G.Y. MAO LAC

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408 S. ROSEMEAD BLVD. SUITE 1
PASADENA CA
91107
US

IV. Provider business mailing address

9724 CORTADA ST APT C
EL MONTE CA
91733-1218
US

V. Phone/Fax

Practice location:
  • Phone: 626-585-9898
  • Fax: 626-585-9898
Mailing address:
  • Phone: 626-350-4322
  • Fax: 626-350-4322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC 9898
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: