Healthcare Provider Details

I. General information

NPI: 1760987465
Provider Name (Legal Business Name): SHUO QIU
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 07/14/2024
Certification Date: 07/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2211 POST ST STE 300
SAN FRANCISCO CA
94115-3442
US

IV. Provider business mailing address

2211 POST ST STE 300
SAN FRANCISCO CA
94115-3442
US

V. Phone/Fax

Practice location:
  • Phone: 540-655-0183
  • Fax:
Mailing address:
  • Phone: 415-483-9223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA175722
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: