Provider Demographics
NPI:1134502719
Name:QUAN YIN MEDICAL CENTER, PA
Entity Type:Organization
Organization Name:QUAN YIN MEDICAL CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GASTON
Authorized Official - Suffix:JR
Authorized Official - Credentials:OMD, AP
Authorized Official - Phone:305-758-7011
Mailing Address - Street 1:217 NE 97TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33138-2403
Mailing Address - Country:US
Mailing Address - Phone:305-758-7011
Mailing Address - Fax:
Practice Address - Street 1:217 NE 97TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-2403
Practice Address - Country:US
Practice Address - Phone:305-758-7011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-01
Last Update Date:2015-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP-1020171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAP1020OtherACUPUNCTURE LICENSE