Provider Demographics
NPI:1356903389
Name:KOU, QI (LAC)
Entity type:Individual
Prefix:
First Name:QI
Middle Name:
Last Name:KOU
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 1:390 BRIDGE PKWY STE 240
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94065-1061
Mailing Address - Country:US
Mailing Address - Phone:650-696-0870
Mailing Address - Fax:
Practice Address - Street 1:390 BRIDGE PKWY STE 240
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94065-1061
Practice Address - Country:US
Practice Address - Phone:650-293-7567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-29
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC18549171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty