Provider Demographics
NPI:1174722748
Name:SHANG, QINGGUO (OMD, LIC AC)
Entity type:Individual
Prefix:DR
First Name:QINGGUO
Middle Name:
Last Name:SHANG
Suffix:
Gender:F
Credentials:OMD, LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3555 MARK TWAIN CT
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-5729
Mailing Address - Country:US
Mailing Address - Phone:614-378-1293
Mailing Address - Fax:
Practice Address - Street 1:1395 E DUBLIN GRANVILLE RD
Practice Address - Street 2:SUITE 418
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43229-3313
Practice Address - Country:US
Practice Address - Phone:614-378-1293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH65.000133171100000X, 171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist