Healthcare Provider Details

I. General information

NPI: 1013665538
Provider Name (Legal Business Name): DI GUAN L.AC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2022
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 E 82ND ST STE 148
BLOOMINGTON MN
55425-1336
US

IV. Provider business mailing address

9133 FOX RUN CIR
EDEN PRAIRIE MN
55347-2027
US

V. Phone/Fax

Practice location:
  • Phone: 612-900-0139
  • Fax:
Mailing address:
  • Phone: 612-380-7831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number1903
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: