Healthcare Provider Details

I. General information

NPI: 1619219409
Provider Name (Legal Business Name): QIU ACUPUNCTURE CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2013
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 E LAS TUNAS DR SUITE 4
SAN GABRIEL CA
91776-1411
US

IV. Provider business mailing address

206 E LAS TUNAS DR SUITE 4
SAN GABRIEL CA
91776-1411
US

V. Phone/Fax

Practice location:
  • Phone: 626-287-3756
  • Fax:
Mailing address:
  • Phone: 626-287-3756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC7176
License Number StateCA

VIII. Authorized Official

Name: MEINA QIU
Title or Position: PROVIDER/OWNER
Credential: L.AC
Phone: 626-287-3756