Provider Demographics
NPI:1083912331
Name:KUANG, QI JIAO (PHARMD)
Entity Type:Individual
Prefix:MS
First Name:QI JIAO
Middle Name:
Last Name:KUANG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2494 SAN BRUNO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94134-1526
Mailing Address - Country:US
Mailing Address - Phone:415-468-4274
Mailing Address - Fax:415-468-4283
Practice Address - Street 1:2494 SAN BRUNO AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94134-1526
Practice Address - Country:US
Practice Address - Phone:415-468-4274
Practice Address - Fax:415-468-4283
Is Sole Proprietor?:No
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH57280183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist