Healthcare Provider Details

I. General information

NPI: 1326240268
Provider Name (Legal Business Name): YING QI LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 TRABUCO RD #218
IRVINE CA
92620
US

IV. Provider business mailing address

4200 TRABUCO RD #218
IRVINE CA
92620
US

V. Phone/Fax

Practice location:
  • Phone: 949-681-0400
  • Fax: 949-681-0401
Mailing address:
  • Phone: 949-681-0400
  • Fax: 949-681-0401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC5774
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: