Provider Demographics
NPI:1497878839
Name:ZHAO, MEDDY SI QING (LAC)
Entity Type:Individual
Prefix:
First Name:MEDDY SI QING
Middle Name:
Last Name:ZHAO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 S ATLANTIC BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-1785
Mailing Address - Country:US
Mailing Address - Phone:626-616-0753
Mailing Address - Fax:
Practice Address - Street 1:212 S ATLANTIC BLVD STE 204
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-1785
Practice Address - Country:US
Practice Address - Phone:626-616-0753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC8683171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC8683OtherSTATE LICENSE