Provider Demographics
NPI:1578673620
Name:FU, QINGQUAN (MD)
Entity Type:Individual
Prefix:
First Name:QINGQUAN
Middle Name:
Last Name:FU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:818 JACKSON ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-4849
Mailing Address - Country:US
Mailing Address - Phone:415-312-9094
Mailing Address - Fax:415-795-9691
Practice Address - Street 1:818 JACKSON ST STE 202
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-4849
Practice Address - Country:US
Practice Address - Phone:415-312-9094
Practice Address - Fax:415-795-9691
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC53780207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2737740Medicaid
CA2737740Medicaid
WI34078600Medicaid