Provider Demographics
NPI:1558598748
Name:QIN, LI YAN
Entity Type:Individual
Prefix:
First Name:LI
Middle Name:YAN
Last Name:QIN
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 1:1431 HANCOCK ST,
Mailing Address - Street 2:2 FLOOR, THAI MASSAGE AND ACUPUNCTURE
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169
Mailing Address - Country:US
Mailing Address - Phone:857-234-6792
Mailing Address - Fax:
Practice Address - Street 1:1431 HANCOCK ST,
Practice Address - Street 2:2 FLOOR, THAI MASSAGE AND ACUPUNCTURE
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169
Practice Address - Country:US
Practice Address - Phone:857-234-6792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4423225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist