Provider Demographics
NPI:1255776167
Name:QI, GOLDEN (LAC)
Entity type:Individual
Prefix:DR
First Name:GOLDEN
Middle Name:
Last Name:QI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:257 W 94TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6945
Mailing Address - Country:US
Mailing Address - Phone:212-662-8882
Mailing Address - Fax:212-662-6886
Practice Address - Street 1:257 W 94TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6945
Practice Address - Country:US
Practice Address - Phone:212-662-8882
Practice Address - Fax:212-662-6886
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2019-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005026171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist