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General NPI Number Information
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NPI Number | 1659596369
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Entity Type | Organization
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Legal Business Name | P.Q. MEDICAL GROUP INC.
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 12/21/2015
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Provider Practice Location Address
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Address Line | 55 S RAYMOND AVE STE 108
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City | ALHAMBRA
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State | CA
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Zip | 91801-7103
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Country | US
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Telephone | 626-642-2002
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Fax |
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Provider Business Mailing Address
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Address Line | 55 S RAYMOND AVE STE 108 1145 W VALLEY BLVD.
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City | ALHAMBRA
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State | CA
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Zip | 91801-7103
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JIN QIANG PAN
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Credential |
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Telephone | 626-642-2002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC10165
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License Number State | CA
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