Healthcare Provider Details

I. General information

NPI: 1174072649
Provider Name (Legal Business Name): WEI QI M. A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MR. GABRIEL QI

II. Dates (important events)

Enumeration Date: 09/26/2016
Last Update Date: 09/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

670 N HILL AVE APT 2
PASADENA CA
91106-1248
US

IV. Provider business mailing address

670 N HILL AVE APT 2
PASADENA CA
91106-1248
US

V. Phone/Fax

Practice location:
  • Phone: 626-657-0409
  • Fax:
Mailing address:
  • Phone: 626-657-0409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: