Provider Demographics
NPI:1902154875
Name:LUO, YONG QIAO (OMD)
Entity Type:Individual
Prefix:DR
First Name:YONG
Middle Name:QIAO
Last Name:LUO
Suffix:
Gender:M
Credentials:OMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 OAKSIDE LANE
Mailing Address - Street 2:SUITE D
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114
Mailing Address - Country:US
Mailing Address - Phone:770-720-1398
Mailing Address - Fax:
Practice Address - Street 1:200 OAKSIDE LANE
Practice Address - Street 2:SUITE D
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114
Practice Address - Country:US
Practice Address - Phone:770-720-1398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-26
Last Update Date:2012-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000017171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist