Provider Demographics
NPI:1467299081
Name:QIU, XIYUAN
Entity type:Individual
Prefix:MR
First Name:XIYUAN
Middle Name:
Last Name:QIU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 S DOBSON RD STE 202
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-6489
Mailing Address - Country:US
Mailing Address - Phone:520-332-0912
Mailing Address - Fax:
Practice Address - Street 1:2222 S DOBSON RD STE 202
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85202-6489
Practice Address - Country:US
Practice Address - Phone:520-332-0912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-11
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-010157171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist