Provider Demographics
NPI:1255673182
Name:QIU, XIAO YUAN (LAC)
Entity Type:Individual
Prefix:MR
First Name:XIAO
Middle Name:YUAN
Last Name:QIU
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 1:113 WATERWORKS WAY STE 305
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-3174
Mailing Address - Country:US
Mailing Address - Phone:949-348-1711
Mailing Address - Fax:949-348-1713
Practice Address - Street 1:113 WATERWORKS WAY STE 305
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-3174
Practice Address - Country:US
Practice Address - Phone:949-348-1711
Practice Address - Fax:949-348-1713
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 4172171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist