Provider Demographics
NPI:1740316439
Name:QIN, YONG XIN (LAC)
Entity type:Individual
Prefix:
First Name:YONG
Middle Name:XIN
Last Name:QIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 W ROUTE 66
Mailing Address - Street 2:SUITE D
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91740-6202
Mailing Address - Country:US
Mailing Address - Phone:626-963-6878
Mailing Address - Fax:626-963-6881
Practice Address - Street 1:102 W ROUTE 66
Practice Address - Street 2:SUITE D
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-6202
Practice Address - Country:US
Practice Address - Phone:626-963-6878
Practice Address - Fax:626-963-6881
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4171171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC0041710Medicaid