Healthcare Provider Details

I. General information

NPI: 1942784269
Provider Name (Legal Business Name): YIQIU HU NMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2018
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3143 N 32ND ST
PHOENIX AZ
85018-6283
US

IV. Provider business mailing address

2448 W LOS LAGOS VIS
MESA AZ
85202-6368
US

V. Phone/Fax

Practice location:
  • Phone: 928-890-4790
  • Fax:
Mailing address:
  • Phone: 928-890-4790
  • Fax: 480-336-2311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number18-1738
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: