Provider Demographics
NPI:1407086499
Name:GONG, QIN QIONG (LAC)
Entity Type:Individual
Prefix:
First Name:QIN
Middle Name:QIONG
Last Name:GONG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2539 S GESSNER RD
Mailing Address - Street 2:SUITE 25
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-2034
Mailing Address - Country:US
Mailing Address - Phone:713-922-8179
Mailing Address - Fax:281-497-2082
Practice Address - Street 1:2539 S GESSNER RD
Practice Address - Street 2:SUITE 25
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-2034
Practice Address - Country:US
Practice Address - Phone:713-922-8179
Practice Address - Fax:281-497-2082
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC00569171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist