Provider Demographics
NPI:1326360793
Name:FU, QIN (LAC)
Entity Type:Individual
Prefix:
First Name:QIN
Middle Name:
Last Name:FU
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 1:415 N EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-6706
Mailing Address - Country:US
Mailing Address - Phone:949-361-2046
Mailing Address - Fax:949-361-3977
Practice Address - Street 1:415 N EL CAMINO REAL
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-6706
Practice Address - Country:US
Practice Address - Phone:949-361-2046
Practice Address - Fax:949-361-3977
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2010-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8341171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist