Provider Demographics
NPI:1164817367
Name:QIU, GANG
Entity Type:Individual
Prefix:
First Name:GANG
Middle Name:
Last Name:QIU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8090 ATLANTIC BLVD APT G92
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32211-8573
Mailing Address - Country:US
Mailing Address - Phone:856-796-0543
Mailing Address - Fax:
Practice Address - Street 1:8090 ATLANTIC BLVD APT G92
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32211-8573
Practice Address - Country:US
Practice Address - Phone:856-796-0543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-03
Last Update Date:2015-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist