Provider Demographics
NPI:1467017517
Name:REN, QIAN (LAC)
Entity type:Individual
Prefix:
First Name:QIAN
Middle Name:
Last Name:REN
Suffix:
Gender:
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7544 113TH ST APT 3A
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-7455
Mailing Address - Country:US
Mailing Address - Phone:646-206-1983
Mailing Address - Fax:
Practice Address - Street 1:141 E 55TH ST APT 9D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4034
Practice Address - Country:US
Practice Address - Phone:646-206-1983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-03
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006516171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty