Provider Demographics
NPI:1922564467
Name:QI, LUAN (LAC)
Entity Type:Individual
Prefix:
First Name:LUAN
Middle Name:
Last Name:QI
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 1:2302 LOGAN ST
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-2648
Mailing Address - Country:US
Mailing Address - Phone:626-271-4615
Mailing Address - Fax:
Practice Address - Street 1:2302 LOGAN ST
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-2648
Practice Address - Country:US
Practice Address - Phone:626-271-4615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-20
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18050171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist