Provider Demographics
NPI:1518362318
Name:QIBO ACUPUNCTURE LLC
Entity Type:Organization
Organization Name:QIBO ACUPUNCTURE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:MACOM, LAC, CMP
Authorized Official - Phone:626-680-8131
Mailing Address - Street 1:973 E VILLA ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-1076
Mailing Address - Country:US
Mailing Address - Phone:626-689-8131
Mailing Address - Fax:
Practice Address - Street 1:973 E VILLA ST
Practice Address - Street 2:SUITE 6
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-1076
Practice Address - Country:US
Practice Address - Phone:626-689-8131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16231171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty