Provider Demographics
NPI:1821221508
Name:SU, QIN HUA (LAC)
Entity Type:Individual
Prefix:
First Name:QIN
Middle Name:HUA
Last Name:SU
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 521475
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11352-1475
Mailing Address - Country:US
Mailing Address - Phone:718-539-7696
Mailing Address - Fax:
Practice Address - Street 1:13329 41ST RD STE 2A
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-3671
Practice Address - Country:US
Practice Address - Phone:718-539-7696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000597171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000597OtherLICENSE