Healthcare Provider Details

I. General information

NPI: 1316082829
Provider Name (Legal Business Name): YIJIN QIU L.AC, DTCM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8354 SIX FORKS RD SUITE 104
RALEIGH NC
27615-3053
US

IV. Provider business mailing address

5305 EAGLES LANDING DR
RALEIGH NC
27616-6155
US

V. Phone/Fax

Practice location:
  • Phone: 919-649-4976
  • Fax:
Mailing address:
  • Phone: 919-649-4976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number90
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: