Provider Demographics
NPI:1477271039
Name:QU, TAO TAO
Entity Type:Individual
Prefix:
First Name:TAO
Middle Name:TAO
Last Name:QU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:904 S 4TH ST APT D
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4341
Mailing Address - Country:US
Mailing Address - Phone:626-238-7096
Mailing Address - Fax:
Practice Address - Street 1:904 S 4TH ST APT D
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4341
Practice Address - Country:US
Practice Address - Phone:626-238-7096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86115183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist