Provider Demographics
NPI:1790572329
Name:QIU, JINJIN
Entity type:Individual
Prefix:
First Name:JINJIN
Middle Name:
Last Name:QIU
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19615 LAKE BOSQUE DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-7920
Mailing Address - Country:US
Mailing Address - Phone:949-395-5729
Mailing Address - Fax:
Practice Address - Street 1:1840 SNAKE RIVER RD STE D
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-7755
Practice Address - Country:US
Practice Address - Phone:254-900-7788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMT140463225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist