Provider Demographics
NPI:1912671363
Name:CINCINNATI ORIENTAL MEDICINE CLINIC
Entity type:Organization
Organization Name:CINCINNATI ORIENTAL MEDICINE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ACUPUNCTURIST
Authorized Official - Prefix:
Authorized Official - First Name:XIAOFEI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANGGUAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-884-0097
Mailing Address - Street 1:3893 LOST WILLOW DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-4758
Mailing Address - Country:US
Mailing Address - Phone:513-884-0097
Mailing Address - Fax:888-847-1235
Practice Address - Street 1:8583 UNIT 5 MASON-MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-9339
Practice Address - Country:US
Practice Address - Phone:513-884-0097
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-08
Last Update Date:2021-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center