Healthcare Provider Details

I. General information

NPI: 1366719858
Provider Name (Legal Business Name): ZHONGXIA QI PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2011
Last Update Date: 11/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 BERRY STREET, SUITE 290, ROOM 2421
SAN FRANCISCO CA
94107-1773
US

IV. Provider business mailing address

451 KANSAS ST UNIT 328
SAN FRANCISCO CA
94107-2358
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-4844
  • Fax: 415-353-4877
Mailing address:
  • Phone: 415-676-1384
  • Fax: 415-353-4877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207SC0300X
TaxonomyClinical Cytogenetics Physician
License NumberMTO 00000499
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: