MEDICARE: JINGYU GU LIC. ACU., O. M. D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	AC00825	TX

General Provider Information

NPI Number	:	1083702872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JINGYU GU LIC. ACU., O. M. D.

Provider Business Mailing Address
First Line	:	5510 DUVAL ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78751-1325
Country	:	US
Telephone Number	:	512-452-5757
Fax Number	:

Provider Business Practice Location Address
First Line	:	1502 W KOENIG LN
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78756-1416
Country	:	US
Telephone Number	:	512-452-5757
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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