Provider Demographics
NPI:1295810794
Name:ZHAI, LIANGQIN
Entity type:Individual
Prefix:
First Name:LIANGQIN
Middle Name:
Last Name:ZHAI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 BROADWAY
Mailing Address - Street 2:SUITE C
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2976
Mailing Address - Country:US
Mailing Address - Phone:310-828-0107
Mailing Address - Fax:310-828-3532
Practice Address - Street 1:2225 BROADWAY
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2976
Practice Address - Country:US
Practice Address - Phone:310-828-0107
Practice Address - Fax:310-828-3532
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC6552171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist