Provider Demographics
NPI:1336777671
Name:QU, YUAN
Entity Type:Individual
Prefix:
First Name:YUAN
Middle Name:
Last Name:QU
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 1:16904 SW LEMONGRASS LN
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-2017
Mailing Address - Country:US
Mailing Address - Phone:858-924-2475
Mailing Address - Fax:
Practice Address - Street 1:16904 SW LEMONGRASS LN
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97007-2017
Practice Address - Country:US
Practice Address - Phone:858-924-2475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-31
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty