Provider Demographics
NPI:1952814121
Name:GONG, QINHUA (LAC)
Entity Type:Individual
Prefix:
First Name:QINHUA
Middle Name:
Last Name:GONG
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 1:12602 TRAIL HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77024-4010
Mailing Address - Country:US
Mailing Address - Phone:832-277-7921
Mailing Address - Fax:
Practice Address - Street 1:427 W 20TH ST STE 209
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-2400
Practice Address - Country:US
Practice Address - Phone:713-922-8179
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01624171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist