Healthcare Provider Details

I. General information

NPI: 1194750612
Provider Name (Legal Business Name): YUMIN QIU M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2438 N PONDEROSA DR BUILDING C, SUITTE 201
CAMARILLO CA
93010-2369
US

IV. Provider business mailing address

1178 S WESTLAKE BLVD UNIT F
WESTLAKE VILLAGE CA
91361-1919
US

V. Phone/Fax

Practice location:
  • Phone: 805-484-4612
  • Fax: 805-496-3841
Mailing address:
  • Phone: 805-405-4377
  • Fax: 805-496-3841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA75287
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA75287
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: