Provider Demographics
NPI:1780180364
Name:QIN, MACK YI
Entity Type:Individual
Prefix:
First Name:MACK
Middle Name:YI
Last Name:QIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 AYERS CIRCLE
Mailing Address - Street 2:BUILDING H-1
Mailing Address - City:KITTERY
Mailing Address - State:ME
Mailing Address - Zip Code:03904
Mailing Address - Country:US
Mailing Address - Phone:207-438-1828
Mailing Address - Fax:207-438-2003
Practice Address - Street 1:1 AYERS CIRCLE
Practice Address - Street 2:BUILDING H-1
Practice Address - City:KITTERY
Practice Address - State:ME
Practice Address - Zip Code:03904
Practice Address - Country:US
Practice Address - Phone:207-438-1828
Practice Address - Fax:207-438-2003
Is Sole Proprietor?:No
Enumeration Date:2018-04-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program