Provider Demographics
NPI:1306959168
Name:QIAO, LI Q (PA)
Entity type:Individual
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First Name:LI
Middle Name:Q
Last Name:QIAO
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Gender:M
Credentials:PA
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Mailing Address - Street 1:12840 RIVERSIDE DR
Mailing Address - Street 2:#300
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3327
Mailing Address - Country:US
Mailing Address - Phone:818-655-9900
Mailing Address - Fax:818-655-9909
Practice Address - Street 1:2825 W 8TH ST
Practice Address - Street 2:102
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-1291
Practice Address - Country:US
Practice Address - Phone:213-380-8998
Practice Address - Fax:213-380-8998
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAPA16087363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical