Provider Demographics
NPI:1417096363
Name:QIU, BOSHENG (MD)
Entity Type:Individual
Prefix:DR
First Name:BOSHENG
Middle Name:
Last Name:QIU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 S GARFIELD AVE STE 248
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-3896
Mailing Address - Country:US
Mailing Address - Phone:626-289-3606
Mailing Address - Fax:626-458-2489
Practice Address - Street 1:330 S GARFIELD AVE STE 248
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3896
Practice Address - Country:US
Practice Address - Phone:626-289-3606
Practice Address - Fax:626-458-2489
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83150207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA83150OtherMEDICAL LINSENSE
CAI16412Medicare UPIN