=====================================================
General NPI Number Information
=====================================================
NPI Number | 1174630800
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GUO YING MAO LAC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 408 S. ROSEMEAD BLVD. SUITE 1
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91107
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-585-9898
-----------------------------------------------------
Fax | 626-585-9898
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9724 CORTADA ST APT C
-----------------------------------------------------
City | EL MONTE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91733-1218
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-350-4322
-----------------------------------------------------
Fax | 626-350-4322
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | AC 9898
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------