Healthcare Provider Details

I. General information

NPI: 1033603600
Provider Name (Legal Business Name): XIAOFEI SHANGGUAN L.AC.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 06/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5887 CORNELL RD
BLUE ASH OH
45242-2026
US

IV. Provider business mailing address

3893 LOST WILLOW DR
MASON OH
45040-4758
US

V. Phone/Fax

Practice location:
  • Phone: 513-884-0097
  • Fax:
Mailing address:
  • Phone: 513-884-0097
  • Fax: 888-847-1235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number65.000351
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: