Healthcare Provider Details

I. General information

NPI: 1447788765
Provider Name (Legal Business Name): BOYUAN QU L.AC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1141 SMITH LANE SUITE 3
ROSEVILLE CA
95661
US

IV. Provider business mailing address

1141 SMITH LANE SUITE 3
ROSEVILLE CA
95661
US

V. Phone/Fax

Practice location:
  • Phone: 916-783-3003
  • Fax: 916-783-4799
Mailing address:
  • Phone: 916-783-3003
  • Fax: 916-783-4799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC17501
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: