Healthcare Provider Details

I. General information

NPI: 1972266138
Provider Name (Legal Business Name): NAOMI XUAN QIN AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2021
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4030 MOORPARK AVE STE 251
SAN JOSE CA
95117-1807
US

IV. Provider business mailing address

7189 BLUE HILL DR
SAN JOSE CA
95129-3622
US

V. Phone/Fax

Practice location:
  • Phone: 669-250-5483
  • Fax:
Mailing address:
  • Phone: 617-922-0113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: