Provider Demographics
NPI:1134664907
Name:DR HU CLINIC INC
Entity Type:Organization
Organization Name:DR HU CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:QIYUE
Authorized Official - Middle Name:
Authorized Official - Last Name:HU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:617-584-2874
Mailing Address - Street 1:3 CANTWELL RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-1705
Mailing Address - Country:US
Mailing Address - Phone:617-584-2874
Mailing Address - Fax:617-209-7728
Practice Address - Street 1:339 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-2438
Practice Address - Country:US
Practice Address - Phone:617-584-2874
Practice Address - Fax:617-209-7728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA223830261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110090792AMedicaid
MA1699733089Medicare PIN
MA144437Medicare UPIN