Provider Demographics
NPI:1750456653
Name:DING, QIN (ACUPUNCTURIST)
Entity type:Individual
Prefix:
First Name:QIN
Middle Name:
Last Name:DING
Suffix:
Gender:F
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 602
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91788
Mailing Address - Country:US
Mailing Address - Phone:909-967-1410
Mailing Address - Fax:815-346-3387
Practice Address - Street 1:19753 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-2136
Practice Address - Country:US
Practice Address - Phone:909-967-1410
Practice Address - Fax:815-346-3387
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC4979171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1461932Medicaid