Provider Demographics
NPI:1669676763
Name:HU, YAN QIU (OMD, LAC)
Entity Type:Individual
Prefix:DR
First Name:YAN QIU
Middle Name:
Last Name:HU
Suffix:
Gender:F
Credentials:OMD, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 MONTANA AVE
Mailing Address - Street 2:SUITE #628
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-1652
Mailing Address - Country:US
Mailing Address - Phone:310-866-3911
Mailing Address - Fax:
Practice Address - Street 1:2130 HUNTINGTON DR
Practice Address - Street 2:#214
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-4964
Practice Address - Country:US
Practice Address - Phone:310-866-3911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2017-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 10671171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist