Provider Demographics
NPI:1033502026
Name:QIN, BOLIN (LAC)
Entity Type:Individual
Prefix:
First Name:BOLIN
Middle Name:
Last Name:QIN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 WINGLEAF CT
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-3202
Mailing Address - Country:US
Mailing Address - Phone:240-813-5388
Mailing Address - Fax:
Practice Address - Street 1:3800 WINGLEAF CT
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20853-3202
Practice Address - Country:US
Practice Address - Phone:240-813-5388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-14
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU02225171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist