Healthcare Provider Details

I. General information

NPI: 1588409544
Provider Name (Legal Business Name): YONGLI QIU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2803 EL CAMINO REAL
SANTA CLARA CA
95051-2901
US

IV. Provider business mailing address

2803 EL CAMINO REAL
SANTA CLARA CA
95051-2901
US

V. Phone/Fax

Practice location:
  • Phone: 408-549-7285
  • Fax:
Mailing address:
  • Phone: 408-549-7285
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95029086
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: