MEDICARE: MR. GANG GUO L. AC.

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	AC14129	CA

General Provider Information

NPI Number	:	1972883098
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GANG GUO L. AC.

Provider Business Mailing Address
First Line	:	18938 LABIN CT
Second Line	:	STE A207
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-2285
Country	:	US
Telephone Number	:	626-965-1439
Fax Number	:

Provider Business Practice Location Address
First Line	:	18938 LABIN CT
Second Line	:	STE A207
City	:	ROWLAND HEIGHTS
State	:	CA
Zip	:	91748-2285
Country	:	US
Telephone Number	:	626-965-1439
Fax Number	:

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

Provider Enumeration Date	:	08/20/2011
Last Update Date	:	10/28/2015

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