Provider Demographics
NPI:1700979101
Name:QIAN, YAO BAI (LAC)
Entity Type:Individual
Prefix:
First Name:YAO
Middle Name:BAI
Last Name:QIAN
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 1:37128 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-4845
Mailing Address - Country:US
Mailing Address - Phone:510-796-1864
Mailing Address - Fax:510-796-1864
Practice Address - Street 1:37128 MAPLE ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-4845
Practice Address - Country:US
Practice Address - Phone:510-796-1864
Practice Address - Fax:510-796-1864
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALAC9219171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist