Healthcare Provider Details

I. General information

NPI: 1174830624
Provider Name (Legal Business Name): DR. YONG QU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2010
Last Update Date: 01/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 MASON STE 100
IRVINE CA
92618-2550
US

IV. Provider business mailing address

5 MASON STE 100
IRVINE CA
92618-2550
US

V. Phone/Fax

Practice location:
  • Phone: 949-812-6902
  • Fax:
Mailing address:
  • Phone: 949-812-6902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZG1000X
TaxonomyMedical Geneticist (PhD) Specialist/Technologist
License NumberDRN12
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code246ZG1000X
TaxonomyMedical Geneticist (PhD) Specialist/Technologist
License NumberQUXXY1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: