Provider Demographics
NPI:1376936625
Name:LI, QINYU
Entity Type:Individual
Prefix:
First Name:QINYU
Middle Name:
Last Name:LI
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 1:8333 BEECHNUT ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-6853
Mailing Address - Country:US
Mailing Address - Phone:281-888-9920
Mailing Address - Fax:281-783-2090
Practice Address - Street 1:8333 BEECHNUT ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036
Practice Address - Country:US
Practice Address - Phone:281-888-9920
Practice Address - Fax:281-783-2090
Is Sole Proprietor?:No
Enumeration Date:2015-03-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2198213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX358543203Medicaid
TX358543202Medicaid
TX358543204Medicaid
TX358543205Medicaid
TX358543201Medicaid
TX358543206Medicaid
TX358543203Medicaid
TX506347ZVXNMedicare PIN
TX506347YUM7Medicare PIN
TX506347ZNDEMedicare PIN
TX358543205Medicaid
TX358543202Medicaid